Concord Repatriation Hospital, Concord, NSW, Australia.
Notre Dame University, Sydney, NSW, Australia.
Ann R Coll Surg Engl. 2022 Jul;104(7):530-537. doi: 10.1308/rcsann.2021.0245. Epub 2021 Nov 22.
Dyspnoea is common in patients with giant paraoesophageal hernia (PEH). Pulmonary aspiration has not previously been recognised as a significant contributory factor. Aspiration pneumonia in association with both gastro-oesophageal reflux disease (GORD) and PEH has a high mortality rate. There is debate about routine anti-reflux measures with surgical repair. Reflux aspiration has been examined in a consecutive cohort using scintigraphic scanning and symptoms.
Reflux aspiration scintigraphy (RASP) results and symptoms were evaluated in consecutive patients with PEH managed in our service between January 2012 and March 2017.
PEH was diagnosed in 96 patients. Preoperative reflux pulmonary scanning was performed in 70 patients: 54 were female (77.1%) and the mean age was 68 years (range 49-85). Dyspnoea was the most common symptom (77.1%), and a symptomatic history of aspiration was seen in 18 patients (25.7%). Clinical aspiration was confirmed by RASP in 13 of these cases. Silent RASP aspiration occurred in a further 27 patients without clinical symptoms. RASP was negative in five patients with clinical symptoms of aspiration. No aspiration by either criterion was present in 27 patients. Dysphagia was negatively related to aspiration on RASP (<0.01), whereas dyspnoea was not (=0.857).
GORD, dyspnoea and silent pulmonary aspiration are frequent occurrences in the presence of giant PEH. Subjective aspiration was the most specific and positive predictor of pulmonary aspiration. Dyspnoea in PEH patients may be caused by pulmonary aspiration, cardiac compression and gas trapping. The high rate of pulmonary aspiration in PEH patients may support anti-reflux repair.
巨大食管裂孔疝（PEH）患者常出现呼吸困难。以前未认识到吸入是一个重要的促成因素。与胃食管反流病（GORD）和 PEH 相关的吸入性肺炎死亡率很高。对于手术修复时是否常规采取抗反流措施存在争议。已经使用闪烁扫描和症状检查来研究连续队列中的反流吸入。
在 2012 年 1 月至 2017 年 3 月期间，我们连续评估了在我们的服务中接受治疗的患有 PEH 的患者的反流吸入闪烁扫描（RASP）结果和症状。
诊断出 96 例 PEH。对 70 例患者进行了术前反流性肺扫描：54 例为女性（77.1％），平均年龄为 68 岁（范围 49-85 岁）。呼吸困难是最常见的症状（77.1％），18 例患者（25.7％）有吸入性症状史。在这些病例中有 13 例通过 RASP 确认了临床性吸入。在没有临床症状的另外 27 例患者中发生了无症状的 RASP 吸入。在有临床症状的 5 例患者中，两种标准均无吸入。在 27 例患者中均无吸入。RASP 与吞咽困难呈负相关（<0.01），而与呼吸困难无关（=0.857）。
GORD、呼吸困难和无症状性肺吸入在巨大 PEH 中经常发生。主观吸入是肺吸入的最特异和最阳性预测指标。PEH 患者的呼吸困难可能是由肺吸入、心脏压迫和气体滞留引起的。PEH 患者肺吸入的发生率很高，可能支持抗反流修复。
