Division of Thoracic and Foregut Surgery, Swedish Cancer Institute and Medical Center, Suite 850, 1101 Madison Street, Seattle, WA 98105, USA.
J Gastrointest Surg. 2011 Mar;15(3):389-96. doi: 10.1007/s11605-010-1324-6. Epub 2011 Jan 19.
Giant paraesophageal hernias (PEH) involve herniation ofstomach and/or other viscera into the mediastinum. These are usually symptomatic and commonly occur in the elderly. The benefits and risks of operating on elderly patients with giant PEH have not been clearly elucidated.
We performed a retrospective chart review of consecutive patients aged 70 or greater with giant PEHs undergoing repair.Quality of life data were gathered using QOLRAD, GERD-HRQL and adysphagia severity score.
Fifty-eight patients (34 females), median 78 years old, presented for repair. Nine patients presented urgently. There was no 30-day mortality. Major morbidity was 15.5%. At mean follow-up of 1.3 years, 81% were symptom free compared to baseline (p < 0.0001). Both short-term (p < 0.001) and long term QOLRAD (p < 0.001) scores improved significantly, as did GERD HRQL scores (p < 0.001). Dysphagia scores worsened in the short term but returned to baseline at long term follow up.
Symptomatic giant PEH in this elderly population can be repaired with symptomatic improvement, minimal morbidity and mortality in both the elective and urgent setting. The decision to operate should be made by a physician experienced in managing this complex patient population.
巨大食管裂孔疝（PEH）是指胃和/或其他内脏疝入纵隔。这些疝通常是有症状的，常见于老年人。对于老年巨大 PEH 患者，手术的获益和风险尚未明确。
我们对连续接受巨大 PEH 修补术的 70 岁及以上患者进行了回顾性图表审查。使用 QOLRAD、GERD-HRQL 和吞咽困难严重程度评分收集生活质量数据。
58 名患者（34 名女性），中位年龄 78 岁，接受了修复。9 名患者紧急就诊。30 天内无死亡病例。主要发病率为 15.5%。平均随访 1.3 年后，81%的患者与基线相比无症状（p < 0.0001）。短期（p < 0.001）和长期 QOLRAD（p < 0.001）评分均显著改善，GERD HRQL 评分也显著改善（p < 0.001）。短期吞咽困难评分恶化，但长期随访时恢复到基线。
在这个老年人群中，有症状的巨大食管裂孔疝可以通过手术修复来缓解症状，无论在择期还是紧急情况下，其发病率和死亡率均较低。是否进行手术应由经验丰富的医生来决定，以管理这一复杂的患者群体。
