Henderson R D, Marryatt G, Henderson R F
Department of Surgery, Women's College Hospital, Toronto, Ont.
Can J Surg. 1988 Sep;31(5):341-5.
Symptoms in patients with hiatal hernia often respond to treatment consisting of diet and medication. Operative procedures, designed to control gastroesophageal reflux and avoid surgically induced problems, are reserved for those with intractable symptoms. When these operative procedures fail, reoperation may be necessary. The reoperative procedure is often technically complex because of esophageal and gastric scar fixation. The authors reviewed the surgical management of recurrent hiatal hernia in 168 patients followed up to 5 years or more; 43 of them had undergone gastric surgery previously.Radiologically, 97% patients studied (142 of 146) had no evidence of anatomic recurrence or reflux post operatively. Manometric studies postoperatively in 114 patients showed that the mean tone of the high pressure zone was within the normal range and lower esophageal disordered motor activity was decreased by 34.5% from the preoperative level. Symptoms of recurrent hiatal hernia were abolished by operation in 88% of the patients; only 4.8% had serious or recurrent symptoms.
食管裂孔疝患者的症状通常对饮食和药物治疗有效。旨在控制胃食管反流并避免手术引起问题的手术操作，仅适用于有顽固性症状的患者。当这些手术操作失败时，可能需要再次手术。由于食管和胃的瘢痕固定，再次手术操作在技术上往往很复杂。作者回顾了168例复发性食管裂孔疝患者的手术治疗情况，随访时间长达5年或更长；其中43例患者此前接受过胃部手术。放射学检查显示，97%接受研究的患者（146例中的142例）术后无解剖学复发或反流迹象。对114例患者进行的术后测压研究表明，高压区的平均张力在正常范围内，食管下括约肌运动紊乱活动较术前水平降低了34.5%。88%的患者经手术消除了复发性食管裂孔疝的症状；只有4.8%的患者有严重或复发性症状。
