Hainaux Bernard, Sattari Azadeh, Coppens Emmanuel, Sadeghi Niloufar, Cadière Guy-Bernard
Department of Radiology, CHU Saint-Pierre, Université Libre de Bruxelles, 322 Rue Haute, 1000 Brussels, Belgium.
AJR Am J Roentgenol. 2002 Apr;178(4):859-62. doi: 10.2214/ajr.178.4.1780859.
The purpose of our study was to evaluate the different types of postoperative herniation of the wrap into the thorax after laparoscopic Nissen fundoplication, to propose a clear radiologic definition, and to establish their respective frequencies.
Two hundred twenty-six consecutive patients who underwent laparoscopic Nissen fundoplication were studied prospectively. All patients underwent an upper gastrointestinal series before surgery and on the first postoperative day. Radiologic follow-up performed yearly after surgery in 148 patients (65%) consisted of a double-contrast upper gastrointestinal series. Intrathoracic migration of the wrap was diagnosed on radiography when the intact fundoplication wrap herniated partially or entirely through the esophageal hiatus of the diaphragm. The kappa statistic was used to assess interobserver agreement.
Of the 148 upper gastrointestinal series, 44 intrathoracic migrations (30%) were diagnosed. These examinations were reviewed and allowed us to differentiate two types of migrations. Type I (31 patients) consists of a paraesophageal hernia of a portion of the wrap through the esophageal hiatus with the esogastric junction remaining below the diaphragm. Type II (13 patients) is diagnosed when the entire fundoplication herniates through the hiatus with the gastroesophageal junction located at or above the level of the diaphragm.
Intrathoracic migration is an important complication of laparoscopic Nissen fundoplication. Most migrations are small and asymptomatic. We propose a simple and reproducible radiologic definition of two different types of intrathoracic migration of the wrap observed after laparoscopic Nissen fundoplication.
我们研究的目的是评估腹腔镜下Nissen胃底折叠术后不同类型的胃底折叠部分疝入胸腔的情况，提出明确的影像学定义，并确定它们各自的发生率。
对连续226例行腹腔镜下Nissen胃底折叠术的患者进行前瞻性研究。所有患者在手术前及术后第一天均接受上消化道造影检查。148例患者（65%）术后每年进行影像学随访，包括双重对比上消化道造影。当完整的胃底折叠部分或全部通过膈肌食管裂孔疝入胸腔时，通过X线诊断胃底折叠的胸腔内移位。kappa统计量用于评估观察者间的一致性。
在148例上消化道造影检查中，诊断出44例胸腔内移位（30%）。对这些检查进行回顾，使我们能够区分两种类型的移位。I型（31例）为部分胃底折叠通过食管裂孔形成食管旁疝，食管胃交界仍位于膈肌下方。当整个胃底折叠通过裂孔疝出且食管胃交界位于膈肌水平或以上时，诊断为II型（13例）。
胸腔内移位是腹腔镜下Nissen胃底折叠术的一种重要并发症。大多数移位较小且无症状。我们提出了一种简单且可重复的影像学定义，用于描述腹腔镜下Nissen胃底折叠术后观察到的两种不同类型的胃底折叠胸腔内移位。
