Trastek V F, Allen M S, Deschamps C, Pairolero P C, Thompson A
Section of General Thoracic Surgery, Mayo Clinic, Rochester, Minn, USA.
J Thorac Cardiovasc Surg. 1996 Nov;112(5):1340-4; discussion 1344-5. doi: 10.1016/S0022-5223(96)70149-6.
From 1985 to 1993, 49 patients (35 women and 14 men) with diaphragmatic hernia and associated anemia underwent surgical repair. The median age was 64.5 years (range 24 to 84 years). Hematologic and gastroenterologic evaluations revealed no other potential cause of bleeding. Each patient had a diaphragmatic hernia. The median time between the diagnosis of anemia and surgical repair was 36 months (range 1 to 334 months). Forty-five patients (91.8%) had received replacement therapy, including iron for 43 and blood transfusions for 32 (median 6 units; range 2 to 70 units). Forty-six patients (93.9%) had symptoms: heartburn in 28, early satiety with bloating in 19, regurgitation in 11, dysphagia in 7, and aspiration in 4. Preoperative upper gastrointestinal endoscopic evaluation demonstrated gastric erosions at the level of the hiatus in 22 patients (44.9%), esophagitis in 7, stenosis in 1, and Barrett's disease in 1. An uncut Collis-Nissen fundoplication was performed in 44 patients, Belsey fundoplication in 2, a cut Collis-Nissen fundoplication, Nissen fundoplication, and Hill repair in 1 each. There was one operative death (2% mortality). Complications occurred in 18 patients (36.7%). Follow-up was complete and ranged from 4 to 103 months (median 63 months). Forty-five patients (91.8%) had resolution of their anemia. Functional results were excellent in 40 patients (81.6%), good in 2 (4.1%), fair in 4 (8.2%), and poor in 3 (6.1%). In most patients with diaphragmatic hernia and associated anemia refractory to medical treatment, surgical repair can result in successful resolution of the anemia.
1985年至1993年，49例患有膈疝并伴有贫血的患者（35名女性和14名男性）接受了手术修复。中位年龄为64.5岁（范围24至84岁）。血液学和胃肠病学评估未发现其他潜在的出血原因。每位患者均患有膈疝。贫血诊断与手术修复之间的中位时间为36个月（范围1至334个月）。45例患者（91.8%）接受了替代治疗，其中43例接受铁剂治疗，32例接受输血治疗（中位输血量为6单位；范围2至70单位）。46例患者（93.9%）有症状：28例有烧心症状，19例有早饱伴腹胀，11例有反流，7例有吞咽困难，4例有误吸。术前上消化道内镜评估显示，22例患者（44.9%）在裂孔水平有胃糜烂，7例有食管炎，1例有狭窄，1例有巴雷特食管病。44例患者进行了未切断的科利斯-尼森胃底折叠术，2例进行了贝尔西胃底折叠术，1例分别进行了切断的科利斯-尼森胃底折叠术、尼森胃底折叠术和希尔修复术。有1例手术死亡（死亡率2%）。18例患者（36.7%）出现并发症。随访完整，时间范围为4至103个月（中位时间63个月）。45例患者（91.8%）贫血得到缓解。40例患者（81.6%）功能结果极佳，2例（4.1%）良好，4例（8.2%）一般，3例（6.1%）较差。在大多数患有膈疝并伴有药物治疗无效的贫血患者中，手术修复可成功解决贫血问题。
