改良Nissen手術在滑動性食管裂孔疝治療中的應用_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

王康武 ,  劉學剛 , 施超 , 劉戈 , 張雷 , 王安生 , 宋超

蚌埠醫學院第一附屬醫院胸心外科，安徽蚌埠 233004;

Corresponding?author：

劉學剛, Email: xgl99@hotmail.com

Keywords：

食管裂孔疝; 外科手術; Nissen手術

DOI：

10.7507/1007-4848.20140201

Video：

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目的評價改良Nissen手術在滑動性食管裂孔疝治療中的應用價值。方法回顧性分析自2001年6月至2013年5月蚌埠醫學院第一附屬醫院52例滑動性食管裂孔疝經手術治療患者的臨床資料，其中男27例、女25例，平均年齡62.13（35～84）歲。所有患者術前均行上消化道X線鋇餐造影、胃鏡檢查確診為滑動性食管裂孔疝，均行改良Nissen手術，即胃底上提至賁門口上方2～3 cm，包繞雙層縫合固定食管180°，并置于膈肌下方。分別于術后3個月、6個月、9個月在平臥頭低位下行消化道X線鋇餐檢查，并長期隨訪，以評價手術效果。結果本組均順利完成手術，無手術死亡，患者術前存在的食管下括約肌松弛和胃酸反流，術后均明顯改善。術后平均住院時間9（5～11）d。52例患者術后2周內復查上消化道X線鋇餐檢查，無胃食管反流。所有患者均隨訪，隨訪時間2個月至10年。除1例術后半年并發食管狹窄外，其余患者均恢復順利，癥狀消失，營養及發育好轉。隨訪期間無復發。結論改良Nissen手術是治療滑動性食管裂孔疝的有效方法，加強食管下段高壓區，折疊胃及賁門口置于膈肌下方，不僅能使胃還納腹腔，同時還有抗反流的效果。

Citation： 王康武, 劉學剛, 施超, 劉戈, 張雷, 王安生, 宋超. 改良Nissen手術在滑動性食管裂孔疝治療中的應用. 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.	蘇志勇.單純大網膜脂肪疝入右側胸腔的食管裂孔疝一例.中國胸心血管外科臨床雜志, 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.	黃青云, 鄭歡, 張霓.食管良性狹窄支架植入術后再狹窄外科治療一例.中國胸心血管外科臨床雜志, 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.	吳鐵鏞.食道裂孔疝.北京醫學, 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.	葉萍, 李兆申, 許國銘, 等.食管裂孔疝伴反流性食管炎患者X線鋇餐與內鏡檢查動力學對比研究.解放軍醫學雜志, 2001, 26(10):718-720.
10.	吳嘉煖, 鞏蘭波, 藍琳, 等.滑動型食管裂孔疝患者高分辨率食管測壓及阻抗-pH監測特點.現代消化及介入診療, 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, 高玉潔, 等.我國胃腸雙對比造影的現狀與應關注的問題.中華放射學雜志, 2001, 35(11):872-875.
14.	張泰昌.食管裂孔疝的內鏡診斷.中華消化內鏡雜志, 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. 蘇志勇.單純大網膜脂肪疝入右側胸腔的食管裂孔疝一例.中國胸心血管外科臨床雜志, 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. 黃青云, 鄭歡, 張霓.食管良性狹窄支架植入術后再狹窄外科治療一例.中國胸心血管外科臨床雜志, 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. 吳鐵鏞.食道裂孔疝.北京醫學, 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. 葉萍, 李兆申, 許國銘, 等.食管裂孔疝伴反流性食管炎患者X線鋇餐與內鏡檢查動力學對比研究.解放軍醫學雜志, 2001, 26(10):718-720.
10. 吳嘉煖, 鞏蘭波, 藍琳, 等.滑動型食管裂孔疝患者高分辨率食管測壓及阻抗-pH監測特點.現代消化及介入診療, 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, 高玉潔, 等.我國胃腸雙對比造影的現狀與應關注的問題.中華放射學雜志, 2001, 35(11):872-875.
14. 張泰昌.食管裂孔疝的內鏡診斷.中華消化內鏡雜志, 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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Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

改良Nissen手術在滑動性食管裂孔疝治療中的應用

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