Harriss D R, Graham T R, Galea M, Salama F D
Department of Thoracic Surgery, City Hospital, Nottingham, UK.
J R Coll Surg Edinb. 1992 Apr;37(2):97-8.
Between 1979 and 1988, 29 cases of paraoesophageal hernia presented to one surgeon (F.D.S.). There were 23 women and six men and the mean(s.e.m.) age was 66.3(4.1) years. All were symptomatic and 13 hernias (45%) were complicated by gastric volvulus, haemorrhage or perforation. Ten (34%) had evidence of gastro-oesophageal reflux, suggesting a sliding component in these cases. Operation, mostly transthoracic, consisted of hernial reduction, crural repair and, if indicated, an antireflux procedure. There were three deaths. Two occurred as a result of spontaneous, intrathoracic perforation of the hernia. The third followed dilatation of a benign stricture 2 months after surgery. The only major complication was a pulmonary embolus with full recovery. The mean(s.e.m.) follow-up time was 47.6(7.8) months and there were no recurrences. This series confirms that symptomatic paraoesophageal hernias warrant early repair because of the frequency and severity of associated complications. Although debate continues as to whether this policy should be extended to asymptomatic paraoesophageal hernias, we suggest that this should be so.
1979年至1988年间，有29例食管旁疝患者就诊于一名外科医生（F.D.S.）。其中女性23例，男性6例，平均（标准误）年龄为66.3（4.1）岁。所有患者均有症状，13例（45%）疝并发胃扭转、出血或穿孔。10例（34%）有胃食管反流的证据，提示这些病例存在滑动成分。手术大多经胸进行，包括疝复位、膈肌脚修补，如有指征则行抗反流手术。有3例死亡。2例因疝的自发性胸内穿孔死亡。第3例在术后2个月因良性狭窄扩张死亡。唯一的主要并发症是肺栓塞，但已完全康复。平均（标准误）随访时间为47.6（7.8）个月，无复发。该系列病例证实，由于相关并发症的发生率和严重程度，有症状的食管旁疝需要早期修复。尽管对于是否应将该策略扩展至无症状食管旁疝仍存在争议，但我们建议应如此。
