胃食管反流病合并食管裂孔疝患者的临床特点分析  

Clinical Characteristics of Gastroesophageal Reflux Disease with Hiatal Hernia

作　　者：潘泓多 孟宪梅 年媛媛 陈洪锁 PAN Hong-duo;MENG Xian-mei;NIAN Yuan-yuan;CHEN Hong-suo(The Second Affiliated Hospital of School of Medicine,Inner Mongolia University of Science and Technology,Baotou,Inner Mongolia 014030)

机构地区：[1]内蒙古科技大学医学院第二附属医院,内蒙古包头014030

出　　处：《智慧健康》2021年第16期76-78,共3页Smart Healthcare

基　　金：内蒙古自治区自然科学基金资助项目(编号2018MS08050)。

摘　　要：目的探析胃食管反流病(GERD)合并食管裂孔疝(HH)患者的临床特点。方法选取本院2020年1月至2020年12月就诊的100例GERD合并HH患者作为观察组,同期未合并HH的100例GERD患者作为对照组,通过问卷调查,比较两组间一般人口学、临床表现及分型、辅助检查特征及临床常用治疗措施。结果观察组与对照组BMI、饮食习惯、精神状态均存在组间统计学差异(P<0.05);且GERD合并HH患者男性发病率略低于女性,≥60岁发病率明显高于低年龄患者,BMI肥胖患者出现HH概率更高,不规律饮食及睡眠不足患者出现HH概率更高。GERD合并HH患者病情严重程度明显高于GERD,存在组间统计学差异(P<0.05)。内镜下检查GERD将表现出食管黏膜破损,Barrett食管表现为柱状上皮呈橘红色,发生于胃食管连接处齿状线近侧。Ⅰ型HH可以观察到膈肌收缩环扩大、松弛,且齿状线上移,胃食管结合部与膈肌收缩环之间距离>2cm;Ⅱ型HH可观察到胃内反转镜头后出现疝囊由食管裂孔旁脱出,疝囊内存在胃黏膜皱襞;Ⅲ型HH可观察到同时兼具I型、Ⅱ型特征。但由于受到干呕、吞咽、呼吸等动作影响会导致胃食管结合部位置发生转变,影响疝囊长度测量。结论 GERD合并HH患者多为BMI较高,饮食习惯及精神状态不佳,表现出胃灼热、吞咽困难、恶心呕吐等症状,根据上述临床特点进行鉴别,及时识别高危患者。Objective To explore the clinical characteristics of gastroesophageal reflux disease (GERD) complicated with hiatal hernia (HH).Methods A total of 100 GERD patients with HH from January 2020 to December 2020 were selected as the observation group and 100 Gerd patients without HH as the control group,the general demography,clinical manifestations and classification,auxiliary examination and clinical treatment were compared between the two groups.Results There was statistical difference between the observation group and the control group in BMI,eating habits and mental status (P<0.05).And the incidence rate of male patients with GERD and HH was slightly lower than that of females,the incidence rate of patients aged 60 or above was significantly higher than that of patients with low age,and the probability of HH occurrence in obese patients was higher.The severity of GERD combined with HH was significantly higher than GERD,and there was statistical difference between the two groups (P<0.05).Endoscopic examination of GERD will show esophageal mucosal damage,Barrett esophagus showed columnar epithelium was orange,occurred in the proximal side of the dentate line of gastroesophageal junction.In typeI HH,the contractile ring of diaphragm was enlarged and relaxed,and the dentate line moved upward,and the distance between gastroesophageal junction and contractile ring of diaphragm was more than 2cm.In typeⅡ HH,the hernial sac prolapsed from the esophageal hiatus and there were gastric mucosal folds in the hernial sac.In type Ⅲ HH,both type Ⅰ and type Ⅱ characteristics were observed.However,due to the influence of retching,swallowing,breathing and other movements,the position of gastroesophageal junction will change,which will affect the measurement of hernia sac length.Conclusion Most of GERD patients with HH have high BMI,poor eating habits and mental state,and show symptoms such as heartburn,dysphagia,nausea and vomiting.

关 键 词：胃食管反流病 食管裂孔疝 临床特点 

分 类 号：R571[医药卫生—消化系统]