胃超声造影与胃镜诊断食管裂孔疝的对比分析

目的对比分析胃镜及超声造影在诊断食管裂孔疝（EHH）中的表现特点，探讨两种检查方法的优劣。方法回顾性分析2010年5月。2012年11月河北省第七人民医院临床高度怀疑为EHH者152例的胃镜及超声造影表现，总结胃镜与超声造影对食管裂孔疝诊断的优点与缺点。结果152例患者胃镜诊断EHH15例，阳性率9．87％，表现为食管胃连接部上移至食管裂孔环之上、门齿距食管胃连接部的距离缩短〈38cm、贲门裂1：3明显增宽或略增宽、膈上可见疝囊腔等。15例显示胃食管连接部上移至食管裂孔环之上，门齿距胃食管连接部距离30～37cm，12例可见疝囊，9例伴反流性食管炎。超声造影诊断EHH13例，阳性率8．55％，表现为膈上疝囊、食管一胃环、腹段食管消失、胃底变浅、部分可见胃壁滑动征、胃底横隔异常等。13例膈上可见疝囊，疝囊直径4．08—5．30cm，10例食管裂孔增宽，8例见胃壁滑动征，7例胃底横隔异常。胃镜诊断为食管裂孔疝的患者中有2例超声造影未见EHH征象，但均可见胃食管反流征象。结论超声造影与胃镜诊断EHH各有优劣，二者应相互结合以提高EHH的诊断准确率，同时又不易造成其他疾病的漏诊误诊。

Comparative analysis of ultrasonography and gastroscope in the diagnosis of esophageal hiatal hernia

Objective To compare the performance characteristics of gastroscope and ultrasound imaging in the diagnosis of esophageal hiatal hernia （EHH） and to explore the merits of both methods. Methods Gastroscope and ultrasound imaging per-formances of 152 patients with clinical suspicion of EHH treated in the Seventh People＇s Hospital of Hebei Province from May 2010 to November 2012 were retrospectively analyzed and the advantages and disadvantages of gastroscope and ultra-sound imaging were compared and summarized. Results Among 152 patients, 15 cases were diagnosed of EHH with gastro-scope, with a positive rate of 9.87%. The performances of gastroscope showed that in EHH patients the esophagogastric junc-tion moved above esophagogastric junction hiatus ring, the distance between incisors and esophagogastric junction shortened to less than 38 cm, cardiac rupture significantly or slightly widened and diaphragmatic hernia was visible. In 15 cases, esoph-agogastric junction moved above esophagogastfic junction hiatus ring and the distance between incisors and esophagogastric junction was 30-37 cm. And diaphragmatic hernia were seen in 12 cases and reflux esophagitis in 9 cases. With ultrasonog-raphy, 13 cases were diagnosed with EHH with a positive rate of 8.55%. The performance of uhrasonography showed that the diaphragm hernia, esophageal-gastric ring and abdominal esophageal disappeared. And the fundus of stomach became shal-low, with some showing visible stomach sliding and gastric diaphragmatic abnormalities. Diaphragmatic hernia was visible in 13 cases, with maximum diameter of 4.08-5.30 cm. Esophageal hiatus widened in 10 cases and gastric sliding was seen in 8 cases and gastric diaphragmatic abnormalities in 7 cases. Among the cases diagnosed with gastroscope, 2 cases showed no signs of EHH with ultrasonography, but all showed visible signs of gastroesophageal reflux. Conclusion Ultrasound imaging and gastroscope both have advantages and disadvantages in the diagnosis of hiatal hernia. It is right to combine the two meth-ods to improve the diagnostic accuracy of hiatal hernia and at the same time avoid misdiagnosis and missed diagnosis.