Section of General Thoracic Surgery, Virginia Mason Medical Center, Seattle, Washington.
Ann Thorac Surg. 2012 Aug;94(2):421-6; discussion 426-8. doi: 10.1016/j.athoracsur.2012.04.058. Epub 2012 Jun 27.
We propose that the symptoms associated with paraesophageal hernia (PEH) are more diverse than previously suggested, and symptoms and clinical manifestations correlate to the anatomy of the hernia.
Patients undergoing surgery for PEH were reviewed from a prospective, institutional review board-approved, single-center database. Presenting symptoms, anatomy of the PEH, demographics, and outcomes were analyzed from 2000 to 2010. Presenting symptoms were assessed for incidence and improvement after surgery. Size and configuration of the PEH were assessed with respect to presenting symptoms.
The study included 270 consecutive patients, 63% were female, and the median age was 70 years (range, 39 to 94 years). The most common presenting symptoms were heartburn in 175 patients (65%), early satiety in 136 patients (50%), chest pain in 130 patients (48%), dyspnea in 130 patients (48%), dysphagia in 129 patients (48%), regurgitation in 128 patients (47%), and anemia in 112 patients (41%). Two hundred sixty-nine patients (99.6%) had at least one symptom; the median number of symptoms was 4 (range, 0 to 10). The type of PEH was II (n=10), III (n=206), and IV (n=54), and the percent intrathoracic stomach was less than 50% (n=33), 50% to 74% (n=86), 75% to 99% (n=55), and 100% (n=96). Paraesophageal hernia type was significantly associated with heartburn (type II/III; p=0.005) and dyspnea (type IV; p=0.007). Significant associations included lower percent intrathoracic stomach with regurgitation (p=0.04); higher percent intrathoracic stomach with early satiety (p=0.02), decreased meal size (p=0.007), and dyspnea (p<0.001); and 50% to 74% intrathoracic stomach with anemia (p=0.001). With a median postoperative follow-up of 103 days, symptoms were subjectively better in patients with dyspnea (67%), early satiety (79%), regurgitation (92%), dysphagia (81%), chest pain (76%), and heartburn (93%).
Paraesophageal hernia is associated with a greater diversity of symptomatic presentation than previously thought. Asymptomatic patients are rare, and size and configuration of the hernia are associated with specific symptoms. Patients with large PEHs should be assessed by an experienced surgeon for elective repair.
我们提出，食管裂孔疝（PEH）相关症状比之前认为的更加多样化，症状和临床表现与疝的解剖结构相关。
回顾了 2000 年至 2010 年期间，在一家机构审查委员会批准的前瞻性单中心数据库中接受 PEH 手术的患者。分析了患者的临床表现、PEH 的解剖结构、人口统计学和结局。评估了术前和术后的症状变化。根据临床表现评估了 PEH 的大小和形态。
本研究纳入了 270 例连续患者，其中 63%为女性，中位年龄为 70 岁（范围 39 至 94 岁）。最常见的临床表现为烧心 175 例（65%）、早饱 136 例（50%）、胸痛 130 例（48%）、呼吸困难 130 例（48%）、吞咽困难 129 例（48%）、反流 128 例（47%）和贫血 112 例（41%）。269 例（99.6%）患者至少有一个症状；中位数为 4 个（范围 0 至 10 个）。PEH 类型为 II 型（n=10）、III 型（n=206）和 IV 型（n=54），胸腔内胃比例<50%（n=33）、50%至 74%（n=86）、75%至 99%（n=55）和 100%（n=96）。PEH 类型与烧心（II/III 型；p=0.005）和呼吸困难（IV 型；p=0.007）显著相关。有显著相关性的因素包括胸腔内胃比例与反流（p=0.04）、胸腔内胃比例与早饱（p=0.02）、进餐量减少（p=0.007）和呼吸困难（p<0.001）、胸腔内胃比例 50%至 74%与贫血（p=0.001）相关。中位术后随访 103 天，呼吸困难（67%）、早饱（79%）、反流（92%）、吞咽困难（81%）、胸痛（76%）和烧心（93%）症状明显改善。
食管裂孔疝与更多样化的症状表现相关，比之前认为的更为复杂。无症状患者罕见，疝的大小和形态与特定症状相关。对于大的食管裂孔疝，应请经验丰富的外科医生进行择期修复。
