Itano Hideki, Okamoto Shiroh, Kodama Kanji, Horita Naokatsu
Department of Thoracic Surgery, Kure Kyosai Hospital, 2-3-28 Nishi-Chuo, Kure, Hiroshima 737-8505, Japan.
Gen Thorac Cardiovasc Surg. 2008 Sep;56(9):446-50. doi: 10.1007/s11748-008-0253-8. Epub 2008 Sep 13.
An 80-year-old woman presented with type IV massive hiatal hernia with intrathoracic upside-down stomach and transverse colon. She was dyspneic and vomited upon consuming food or water. Consequently, she developed aspiration pneumonia. Both esophagoscopy and upper gastrointestinal series demonstrated significant cephalad displacement of the gastroesophageal junction. A Collis-Nissen hernial repair by muscle-sparing mini-thoracotomy was performed successfully. To date, 3 years after surgery, the patient is enjoying normal oral intake, has an excellent activities of daily living level, and there is no hernia recurrence. Cases of massive paraesophageal hernia are frequently associated with esophageal shortening that causes tension on the repairs and late failure. Advantages of the transthoracic approach in such cases include feasibility of direct esophageal mobilization, accurate assessment of esophageal tension, and facilitation of Collis gastroplasty. The true indication for transthoracic Collis-Nissen repair among cases of paraesophageal hiatal hernia with a short esophagus should be acknowledged more in the era of laparoscopy.
一名80岁女性因IV型巨大食管裂孔疝合并胸腔内胃和横结肠倒置前来就诊。她进食或饮水时会出现呼吸困难和呕吐，进而发展为吸入性肺炎。食管镜检查和上消化道造影均显示胃食管交界处明显向头侧移位。通过保留肌肉的小切口开胸手术成功实施了科利斯-尼森疝修补术。迄今为止，术后3年，患者能够正常经口进食，日常生活活动水平良好，且无疝复发。巨大食管旁疝病例常伴有食管缩短，这会导致修补处张力增加和后期失败。在此类病例中，经胸入路的优点包括直接游离食管的可行性、准确评估食管张力以及便于实施科利斯胃成形术。在腹腔镜时代，对于食管短的食管旁裂孔疝病例，经胸科利斯-尼森修补术的真正适应证应得到更多认可。
