改良Nissen手术在滑动性食管裂孔疝治疗中的应用_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

王康武 ,  刘学刚 , 施超 , 刘戈 , 张雷 , 王安生 , 宋超

蚌埠医学院第一附属医院胸心外科，安徽蚌埠 233004;

Corresponding author：

刘学刚, Email: xgl99@hotmail.com

Keywords：

食管裂孔疝; 外科手术; Nissen手术

DOI：

10.7507/1007-4848.20140201

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目的评价改良Nissen手术在滑动性食管裂孔疝治疗中的应用价值。方法回顾性分析自2001年6月至2013年5月蚌埠医学院第一附属医院52例滑动性食管裂孔疝经手术治疗患者的临床资料，其中男27例、女25例，平均年龄62.13（35～84）岁。所有患者术前均行上消化道X线钡餐造影、胃镜检查确诊为滑动性食管裂孔疝，均行改良Nissen手术，即胃底上提至贲门口上方2～3 cm，包绕双层缝合固定食管180°，并置于膈肌下方。分别于术后3个月、6个月、9个月在平卧头低位下行消化道X线钡餐检查，并长期随访，以评价手术效果。结果本组均顺利完成手术，无手术死亡，患者术前存在的食管下括约肌松弛和胃酸反流，术后均明显改善。术后平均住院时间9（5～11）d。52例患者术后2周内复查上消化道X线钡餐检查，无胃食管反流。所有患者均随访，随访时间2个月至10年。除1例术后半年并发食管狭窄外，其余患者均恢复顺利，症状消失，营养及发育好转。随访期间无复发。结论改良Nissen手术是治疗滑动性食管裂孔疝的有效方法，加强食管下段高压区，折叠胃及贲门口置于膈肌下方，不仅能使胃还纳腹腔，同时还有抗反流的效果。

Citation： 王康武, 刘学刚, 施超, 刘戈, 张雷, 王安生, 宋超. 改良Nissen手术在滑动性食管裂孔疝治疗中的应用. Chinese Journal of Clinical Thoracic and Cardiovascular Surgery, 2014, 21(5): 700-702. doi: 10.7507/1007-4848.20140201 Copy

1.	Kahrilas PJ, Lee TJ. Pathophysiology of gast roesophageal reflux disease. Thorac Surg Clin, 2010, 15(3):323-333.
2.	苏志勇.单纯大网膜脂肪疝入右侧胸腔的食管裂孔疝一例.中国胸心血管外科临床杂志, 2010, 17(3):214.
3.	Maziak DE, Todd TR, Pearson FG, et al. Massive hiatus hernia: evaluation and surgical management. J Thora Cardiovasc Surg, 1998, 115(1):53-60.
4.	黄青云, 郑欢, 张霓.食管良性狭窄支架植入术后再狭窄外科治疗一例.中国胸心血管外科临床杂志, 2013, 20(1):37.
5.	Fornari F, Fucilini LM, Risson C, et al. Contribution of standard oesophageal manometry in sliding hiatal hernia:from the gastro-oesophageal pressure gradient to the diagnosis. Dig Liver Dis, 2009, 41(12):886-890.
6.	吴铁镛.食道裂孔疝.北京医学, 2012, 17(6):35-37.
7.	Vela MF, Camacho-Lobato L, Srinivasan R, et al. Simultaneous intraesophageal impedance and pH measurement of acid and nonacid gastroesophageal reflux:Effect of omeprazole. Gastroenterology, 2001, 120(7):1599-1606.
8.	Sifrim D, Castell D, Dent J, et al. Gastro-oesophageal reflux monitoring:review and consensus report on detection and definitions of acid, non-acid, and gas reflux. Gut, 2004, 53(7):1024-1031.
9.	叶萍, 李兆申, 许国铭, 等.食管裂孔疝伴反流性食管炎患者X线钡餐与内镜检查动力学对比研究.解放军医学杂志, 2001, 26(10):718-720.
10.	吴嘉煖, 巩兰波, 蓝琳, 等.滑动型食管裂孔疝患者高分辨率食管测压及阻抗-pH监测特点.现代消化及介入诊疗, 2010, 15(3):136-140.
11.	Kahrilas PJ, Kim HC, Pandolfino JE. Approaches to the diagnosis and grading of hiatal hernia. Best Pract Res Clin Gastroenterol, 2008, 22(4):601-616.
12.	Salvador R, Dubecz A, Polomsky M, et al. A new era in esophageal diagnostics:the image-based paradigm of high-resolution manometry. J Am Coll Surg, 2009, 208(6):1035-1044.
13.	尚克中, 程英升, 高玉洁, 等.我国胃肠双对比造影的现状与应关注的问题.中华放射学杂志, 2001, 35(11):872-875.
14.	张泰昌.食管裂孔疝的内镜诊断.中华消化内镜杂志, 2004, 21(5):293-296.
15.	Bredenoord AJ, Weusten BL, Carmagnola S, et al. Double-peaked high-pressure zone at the esophagogastric junction in controls and in patients with a hiatal hernia:a study using high-resolution manometry. Dig Dis Sci, 2004, 49(7/8):1128-1135.
16.	Ye P, Li ZS, Xu GM, et al. Esophageal motility in patients with sliding hiatal hernia with reflux esophagitis. Chin Med J, 2008, 121(10):898-903.

1. Kahrilas PJ, Lee TJ. Pathophysiology of gast roesophageal reflux disease. Thorac Surg Clin, 2010, 15(3):323-333.
2. 苏志勇.单纯大网膜脂肪疝入右侧胸腔的食管裂孔疝一例.中国胸心血管外科临床杂志, 2010, 17(3):214.
3. Maziak DE, Todd TR, Pearson FG, et al. Massive hiatus hernia: evaluation and surgical management. J Thora Cardiovasc Surg, 1998, 115(1):53-60.
4. 黄青云, 郑欢, 张霓.食管良性狭窄支架植入术后再狭窄外科治疗一例.中国胸心血管外科临床杂志, 2013, 20(1):37.
5. Fornari F, Fucilini LM, Risson C, et al. Contribution of standard oesophageal manometry in sliding hiatal hernia:from the gastro-oesophageal pressure gradient to the diagnosis. Dig Liver Dis, 2009, 41(12):886-890.
6. 吴铁镛.食道裂孔疝.北京医学, 2012, 17(6):35-37.
7. Vela MF, Camacho-Lobato L, Srinivasan R, et al. Simultaneous intraesophageal impedance and pH measurement of acid and nonacid gastroesophageal reflux:Effect of omeprazole. Gastroenterology, 2001, 120(7):1599-1606.
8. Sifrim D, Castell D, Dent J, et al. Gastro-oesophageal reflux monitoring:review and consensus report on detection and definitions of acid, non-acid, and gas reflux. Gut, 2004, 53(7):1024-1031.
9. 叶萍, 李兆申, 许国铭, 等.食管裂孔疝伴反流性食管炎患者X线钡餐与内镜检查动力学对比研究.解放军医学杂志, 2001, 26(10):718-720.
10. 吴嘉煖, 巩兰波, 蓝琳, 等.滑动型食管裂孔疝患者高分辨率食管测压及阻抗-pH监测特点.现代消化及介入诊疗, 2010, 15(3):136-140.
11. Kahrilas PJ, Kim HC, Pandolfino JE. Approaches to the diagnosis and grading of hiatal hernia. Best Pract Res Clin Gastroenterol, 2008, 22(4):601-616.
12. Salvador R, Dubecz A, Polomsky M, et al. A new era in esophageal diagnostics:the image-based paradigm of high-resolution manometry. J Am Coll Surg, 2009, 208(6):1035-1044.
13. 尚克中, 程英升, 高玉洁, 等.我国胃肠双对比造影的现状与应关注的问题.中华放射学杂志, 2001, 35(11):872-875.
14. 张泰昌.食管裂孔疝的内镜诊断.中华消化内镜杂志, 2004, 21(5):293-296.
15. Bredenoord AJ, Weusten BL, Carmagnola S, et al. Double-peaked high-pressure zone at the esophagogastric junction in controls and in patients with a hiatal hernia:a study using high-resolution manometry. Dig Dis Sci, 2004, 49(7/8):1128-1135.
16. Ye P, Li ZS, Xu GM, et al. Esophageal motility in patients with sliding hiatal hernia with reflux esophagitis. Chin Med J, 2008, 121(10):898-903.

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