重度食管裂孔疝患者CT和胃镜表现及内外科治疗效果分析  

The CT and gastroscopic findings and comparison of medical and surgical treatment in patients with severe hiatus hernia

作　　者：任伟霞 杨秀清 刘荫荣 张鸿 袁俊华 REN Weixia;YANG Xiuqing;LIU Yinrong;ZHANG Hong;YUAN Junhua(Department of Geriatric Gastroenterology,Shandong Provincial Hospital Affiliated to Shandong First Medical University,Jinan 250021,P.R.China;Department of Geriatrics,Shandong Provincial Hospital Affiliated to Shandong First Medical University,Jinan 250021,P.R.China;Physical Examination Center,Shandong Provincial Hospital affiliated to Shandong First Medical University,Jinan 250021,P.R.China)

机构地区：[1]山东第一医科大学附属省立医院老年消化病科,山东济南250021 [2]山东第一医科大学附属省立医院老年病科,山东济南250021 [3]山东第一医科大学附属省立医院查体中心,山东济南250021

出　　处：《医学影像学杂志》2021年第7期1196-1199,共4页Journal of Medical Imaging

摘　　要：目的观察重度食管裂孔疝患者的CT和胃镜表现,并分析内外科治疗间的疗效。方法回顾性收集本院66例经螺旋CT或胃镜证实Ⅳ型食管裂孔疝患者,分析其CT和胃镜检查结果。30例患者保守治疗,给予禁食、胃肠减压、抑酸、补液等;腹腔镜下HH修补术的患者36例;治疗后均好转出院。回顾性分析两组患者临床症状缓解时间、并发症发生率、住院时间、住院总费用等各项指标。结果内科保守治疗与外科腹腔镜治疗相比较,患者烧灼感、反酸、恶心、腹胀、胸骨后/剑突下疼痛等症状改善所用时间较长;但吞咽困难、纵隔腔积液等并发症发生率较低(3.3%vs 25.0%;0.0%vs 16.7%);与外科腹腔镜治疗组相比,内科保守治疗组住院时间相对较长(14.57±3.53 vs 8.11±1.51),但住院总费用较低(2.02±0.74 vs 4.49±0.99),二者之间的差异均具有统计学意义。结论重度食管裂孔疝患者的内科保守治疗与外科腹腔镜治疗相比较,各有优势。Objective To observe the CT and gastroscopic findings of patients with severe Hiatus Hernia,and to compare the efficacy between medical and surgical treatment.Methods 66 Patients with type IV Hiatus Hernia confirmed by spiral CT or gastroscopy were collected retrospectively.The results of CT and gastroscopy were analyzed firstly.Among them,30 patients underwent conservative treatment,including fasting,gastrointestinal decompression,acid suppression and fluid replacement;36 patients underwent laparoscopic Hiatus Hernia;all patients were discharged after treatment.We retrospectively analyzed and compared the clinical symptom remission time,complication rate,length of stay,and the total cost of stay in the two treatment groups.Results Compared with laparoscopic surgery,conservative treatment in internal medicine took longer time to improve the symptoms such as burning sensation,acid regurgitation,nausea,abdominal distension and post sternal/subxiphoid pain.But the incidence of complications such as dysphagia and mediastinal effusion was lower(3.3%vs 25.0%;0.0%vs 16.7%).The hospitalization time of medical conservative treatment group was longer than that of surgical laparoscopic treatment group(14.57±3.53 vs 8.11±1.51),but the total cost of hospitalization was lower(2.02±0.74 vs 4.49±0.99).Conclusion Compared with the surgical laparoscopic treatment,the medical conservative treatment of severe hiatus hernia had its advantages.

关 键 词：食管裂孔疝 体层摄影术 X线计算机 

分 类 号：R571[医药卫生—消化系统] R814.42[医药卫生—内科学]