Department of General Surgery, General Hospital Zell am See, Zell am See, Austria.
Dis Esophagus. 2012 Apr;25(3):201-8. doi: 10.1111/j.1442-2050.2011.01238.x. Epub 2011 Sep 2.
Hiatal hernia is an underlying factor contributing to gastroesophageal reflux disease (GERD). However, it remains elusive whether the size of the esophageal hiatus has a de facto influence on the lower esophageal sphincter (LES), on the intensity of patient reflux, on GERD symptoms and on the quality of life (QoL). One hundred patients with documented chronic GERD underwent laparoscopic fundoplication. QoL was evaluated before surgery using the Gastrointestinal Quality of Life Index (GIQLI). Additionally, GERD symptoms and nonspecific gastrointestinal symptoms were documented using a standardized questionnaire (score 0-224). The size of the esophageal hiatus was measured during surgery by calculating the hiatal surface area (HSA). Correlation analysis between the preoperative QoL, GERD symptoms, esophageal manometry, multichannel intraluminal impedance monitoring data and HSA size was performed, in order to investigate whether the HSA has an influence on the patients'symptoms, GIQLI, manometry and multichannel intraluminal impedance monitoring data. Statistical significance was set at a P-value of 0.05. The HSA sizes ranged from 1.51cm(2) to 16.09cm(2) (mean 4.14cm(2) ). The preoperative GIQLI ranged from 15 points to 133 points (mean 94.37 points). Symptom scores ranged from 2 points to 192 points (mean 49.84 points). No significant influence of the HSA on GIQLI or preoperative symptoms was recorded. HSA size had a significant negative effect on LES pressure. Additionally, there was a significant positive correlation between HSA size and number of refluxes in supine position. For the rest of the evaluated data, including DeMeester score, total number of refluxes, refluxes in upright position, acid reflux events, proximal reflux events, LES length and body motility, no significant correlation was found. Although patients subjectively are not significantly affected by the size of the hiatus, it has significant effects on the LES pressure and on gastroesopageal reflux in supine position.
食管裂孔疝是胃食管反流病（GERD）的一个潜在因素。然而，食管裂孔的大小是否实际上对食管下括约肌（LES）、患者反流的强度、GERD 症状和生活质量（QoL）有影响，仍然难以确定。100 例有明确慢性 GERD 病史的患者接受了腹腔镜胃底折叠术。手术前使用胃肠道生活质量指数（GIQLI）评估 QoL。此外，使用标准化问卷（评分 0-224）记录 GERD 症状和非特异性胃肠道症状。在手术过程中通过计算裂孔表面积（HSA）来测量食管裂孔的大小。对术前 QoL、GERD 症状、食管测压、多通道腔内阻抗监测数据与 HSA 大小之间的相关性进行分析，以研究 HSA 是否对患者的症状、GIQLI、测压和多通道腔内阻抗监测数据有影响。统计学意义设定为 P 值<0.05。HSA 大小范围为 1.51cm²至 16.09cm²（平均 4.14cm²）。术前 GIQLI 范围为 15 分至 133 分（平均 94.37 分）。症状评分范围为 2 分至 192 分（平均 49.84 分）。未记录到 HSA 对 GIQLI 或术前症状有显著影响。HSA 大小对 LES 压力有显著的负影响。此外，HSA 大小与仰卧位反流次数之间存在显著的正相关。对于其余评估数据，包括 DeMeester 评分、总反流次数、直立位反流次数、酸反流事件、近端反流事件、LES 长度和体动，均未发现显著相关性。尽管患者主观上不受裂孔大小的影响，但裂孔大小对 LES 压力和仰卧位胃食管反流有显著影响。
