Myllärniemi H, Saario I
Ann Surg. 1985 Aug;202(2):159-61. doi: 10.1097/00000658-198508000-00004.
A series of patients showing a previously unrecognized type of sliding hiatus hernia is presented and analyzed. This type of hernia is characterized by reflux of the mucous membrane of the Hiss angle into the lumen of the esophagus. The occurrence of mucosal prolapse is a secondary phase of gastroesophageal reflux. The mucous plug prevents further reflux of the acid contents of the stomach into the esophagus and mouth. After the appearance of mucosal prolapse, the symptoms and signs of esophagitis disappear. The most characteristic complaint of the patients is retrosternal pain on lying and bending down. Endoscopy with provocative tests reveals the mucosal prolapse. Tooth erosions due to previous acid reflux into the mouth are diagnostic. The symptoms of this new subtype of sliding hiatus hernia were cured by the Nissen fundoplication.
本文呈现并分析了一系列表现出一种此前未被认识的滑动型食管裂孔疝的患者。这种类型的疝的特征是希氏角的黏膜反流至食管腔内。黏膜脱垂的发生是胃食管反流的继发阶段。黏液栓可防止胃内酸性内容物进一步反流至食管和口腔。黏膜脱垂出现后，食管炎的症状和体征消失。患者最典型的主诉是平卧和弯腰时胸骨后疼痛。内镜检查及激发试验可发现黏膜脱垂。既往酸性物质反流至口腔导致的牙齿侵蚀具有诊断意义。这种新型滑动型食管裂孔疝的症状通过nissen胃底折叠术得以治愈。
