Kakarlapudi G V, Awad Z T, Haynatzki G, Sampson T, Stroup G, Filipi C J
Department of Surgery, Suite 3740, Creighton University School of Medicine, 601 N 30th Street, Omaha, NE 68131-2197, USA.
Hernia. 2002 Dec;6(4):163-6. doi: 10.1007/s10029-002-0081-1. Epub 2002 Sep 17.
Hiatal disruption is one of the common mechanisms of failure after Nissen fundoplication. We investigated the correlation between various diaphragm stressors and disruption of the diaphragmatic closure. Thirty-seven patients with a hiatal hernia recurrence of 2 cm or greater, as proven by esophagram, endoscopy, or operative findings, were included. A retrospective analysis was conducted utilizing a standardized diaphragm stressor questionnaire for the study group and a control group of 50 patients without hiatal hernia recurrence. Logistic regression was used to determine the significant predictors of hiatal hernia recurrence. Three predictors emerged in the final model: weight lifting (P < 0.0174), vomiting (P < 0.0313) and hiccoughing (P < 0.2472). Of these, only vomiting and weight lifting were significant. The odds ratio for weight lifting is OR = 3.662 (95% CI: 1.256-10.676), and for vomiting it is OR = 4.938 (95% CI: 1.154-21.126). Vomiting or heavy weight lifting is a significant predictor of hiatal hernia recurrence.
食管裂孔破坏是nissen胃底折叠术后常见的失败机制之一。我们研究了各种膈肌应激源与膈肌闭合破坏之间的相关性。纳入了37例经食管造影、内镜检查或手术发现证实食管裂孔疝复发2厘米或更大的患者。利用标准化的膈肌应激源问卷对研究组和50例无食管裂孔疝复发的对照组进行回顾性分析。采用逻辑回归确定食管裂孔疝复发的显著预测因素。最终模型中出现了三个预测因素：举重（P<0.0174）、呕吐（P<0.0313）和打嗝（P<0.2472）。其中，只有呕吐和举重具有显著性。举重的比值比为OR = 3.662（95%CI：1.256 - 10.676），呕吐的比值比为OR = 4.938（95%CI：1.154 - 21.126）。呕吐或重度举重是食管裂孔疝复发的显著预测因素。
