El Sherif Amr, Yano Fumiaki, Mittal Sumeet, Filipi Charles J
Department of surgery, Suite 3740, Creighton University School of Medicine, 601 N 30th Street, Omaha, NE 68131-2197, USA.
Hernia. 2006 Dec;10(6):511-20. doi: 10.1007/s10029-006-0152-9.
Hiatus hernia (HH) is a condition characterized by herniation of the intra-abdominal organs into the thorax. Of the several types that have been identified, the most common is type I (sliding) HH. Congenital predisposition and acquired factors, for example trauma and iatrogeny, have been identified as causative factors. There is a strong association between gastroesophageal reflux disease and HH-the prevalence of reflux in HH may reach 94%. Many methods have been used to treat reflux disease and HH, among which are laparoscopic techniques, which gained popularity as a safe method of treatment. Primary crural repair without mesh application was found to have a recurrence rate of up to 42%. This led to the introduction of mesh in HH repair, which was associated with a significant decrease in recurrence rate. Collagen and its relation to hernia have been investigated for several decades. Collagen has mechanical properties sufficient to enable it to support healed scars and other tissues. Nineteen distinct types of collagen have been recognized, the most common of which are types I and III. Type III collagen is the major constituent of early granulation tissue whereas type I predominates as healing proceeds. Collagen fibers are imbedded in extracellular matrix (ECM), which is in continuous process of synthesis and degradation under the action of matrix metalloproteinases. Many authors have studied the role of collagen in ventral hernia and have even defined hernia as a disease of the ECM. The relationship between collagen and HH, and its recurrence, is not fully understood and needs further investigation.
食管裂孔疝（HH）是一种以腹腔内器官疝入胸腔为特征的病症。在已确定的几种类型中，最常见的是I型（滑动型）HH。先天性易患因素和后天因素，如创伤和医源性因素，已被确定为致病因素。胃食管反流病与HH之间存在密切关联——HH中反流的患病率可能高达94%。已经使用了多种方法来治疗反流病和HH，其中腹腔镜技术作为一种安全的治疗方法而受到欢迎。发现不使用补片的原发性膈肌脚修复的复发率高达42%。这导致在HH修复中引入补片，这与复发率的显著降低相关。胶原蛋白及其与疝的关系已经研究了几十年。胶原蛋白具有足够的机械性能，能够支撑愈合的疤痕和其他组织。已经识别出19种不同类型的胶原蛋白，其中最常见的是I型和III型。III型胶原蛋白是早期肉芽组织的主要成分，而随着愈合的进行，I型胶原蛋白占主导地位。胶原纤维嵌入细胞外基质（ECM）中，在基质金属蛋白酶的作用下，细胞外基质处于持续的合成和降解过程中。许多作者研究了胶原蛋白在腹疝中的作用，甚至将疝定义为一种细胞外基质疾病。胶原蛋白与HH及其复发之间的关系尚未完全了解，需要进一步研究。
