滑动型食管裂孔疝的外科治疗

目的 探讨滑动型食管裂孔疝手术治疗的方法与效果。方法 对经X线钡餐及胃镜检查确诊的52例滑动型食管裂孔疝并食管炎患者行手术治疗,其中Nissen手术47例、Hill手术3例、Boerema手术1例、Rampal手术1例,于术前、术后进行24h食管pH值和食管压力监测。以健康志愿者30例为对照组,行24h食管pH值和食管压力监测。结果 手术组患者术前均存在食管下括约肌的松弛和酸反流,术后则明显改善。52例随访患者中疗效优者33例(63％)、良者14例(27％)、欠佳者3例(2例吞咽困难、1例反流,占6％)、差者2例(2例复发,占4％)。结论 应完善术前检查及正确、严格掌握手术指征,以取得良好的手术疗效;术式以经腹短松式Nissen术为最佳。

Surgical treatment with sliding esophageal hiatal hernia

OBJECTIVE: To study the effect and method of surgical treatment in patients with sliding esophageal hiatal hernia. METHODS: To divide into two groups: fifty-two patients with sliding esophageal hiatal hernia diagnosed with gastroscopy and X-ray barium meal examination accepted operation. Forty-seven cases were treated by Nissen's operation. Three cases were treated by Hill's operation. One case was treated by Boerema's operation. One case was treated by Rampal's operation. 24-hour esophageal pH and esophageal motility were also monitored before and after operation. Thirty healthy volunteer were performed control group and were monitored by 24-hour esophageal pH and esophageal motility. RESULTS: The patients in operation group had lower esophageal sphincter relaxation and acid reflux before operation. They became significantly ameliorative after operation. Forty-seven cases (90%) had the satisfactory effect. Two cases (4%) recrudesced. CONCLUSION: Comprehensive examination and perfect surgical choice may play an important role in the treatment of sliding esophageal hiatal hernia; The better method for sliding esophageal hiatal hernia is Nissen's operation.