Kramer P
Gastroenterology. 1969 Oct;57(4):442-8.
In a sliding hiatus hernia, the esophagogastric junction is above the diaphragm. It is called a sliding hernia because anatomically it resembles a sliding inguinal hernia and not because of an upward and downward motion through the esophageal hiatus. Symptoms may arise from the hernia because it becomes distended or bleeds; much more commonly the hernia is said to produce gastroesophageal reflux with its secondary complications. However, certain clinical and manometric data suggest that the hernia may be an associated and inconsequential finding so that reflux probably depends upon the lower esophageal sphincter efficiency rather than the presence of a hernia. The role of the phrenoesophageal ligament and its actual existence are still debated. A lower esophageal ring cannot be assumed to indicate that a hernia is present; more than likely the ring marks the upper limits of the lower esophageal sphincter. Although inadequate data are available concerning the natural history of the symptom complex attributed to a hernia, in a large proportion of such patients, symptoms become mild or may disappear on so-called medical therapy. Consequently, the results of surgical therapy need to be cautiously evaluated.
在滑动型食管裂孔疝中，食管胃交界处位于膈肌上方。之所以称为滑动疝，是因为从解剖学角度看它类似于滑动性腹股沟疝，而非因其通过食管裂孔上下移动。症状可能源于疝囊扩张或出血；更常见的说法是，疝会导致胃食管反流及其继发并发症。然而，某些临床和测压数据表明，疝可能是一个相关但无关紧要的发现，因此反流可能取决于食管下括约肌的功能，而非疝的存在。膈食管韧带的作用及其实际存在仍存在争议。不能认为食管下环就表明存在疝；很可能该环标志着食管下括约肌的上限。尽管关于归因于疝的症状复合体的自然史数据不足，但在很大一部分此类患者中，症状会减轻或在所谓的药物治疗后可能消失。因此，手术治疗的结果需要谨慎评估。
