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目的 评价小儿食管裂孔疝外科治疗的疗效。方法 1981年 3月～ 2 0 0 0年 10月修补裂孔疝 2 1例 ,并做 3种抗反流手术 (重建His角 ,Belsey手术及Nissen手术 ) ;术后根据临床表现、X线钡餐检查、食管测压及 2 4hpH监测 ,评价手术疗效。 结果 无手术死亡。 2例再次修补滑动疝 ,1例并发反流性食管溃疡于术后 9年切除食管下段后行食管胃吻合。术后随访 8～ 14年 9例 ,4～ 5年 2例 ,2～ 3年 6例 ,6～ 10个月 3例及 2个月 1例 ;术前症状均消失 ,体重、身高增加 ;X线钡餐检查 :2 0例贲门位膈下 ,钡剂通过顺畅 ,无胃食管反流 ;2例食管下括约肌有高压带 ,pH总计分基本正常。结论 食管裂孔疝修补术附加 3种抗反流手术 ,疗效均良好 ,如无并发短食管及食管狭窄可经腹修补及重建His角抗反流。
Objective To evaluate the efficacy of surgical treatment of pediatric hiatal hernia. Methods From March 1981 to October 2000, 21 cases were repaired of hiatal hernia, and 3 kinds of anti-reflux surgery (reconstructed His angle, Belsey operation and Nissen operation) were performed. According to the clinical manifestations, X-ray barium meal examination , Esophageal manometry and 24 hpH monitoring, evaluation of surgical efficacy. The result was no operative death. 2 cases of repaired sliding hernia, 1 case of concurrent reflux of esophageal ulcer 9 years after resection of the lower esophagus esophagogastric anastomosis. The patients were followed up for 8 to 14 years, 9 cases, 4 to 5 years in 2 cases, 2 to 3 years in 6 cases, 6 to 10 months in 3 cases and 2 months in 1 case. The symptoms disappeared and the body weight and height increased. X Line barium meal examination: 20 cases of cardia under the diaphragm, barium smooth, no gastroesophageal reflux; 2 cases of esophageal sphincter with high pressure zone, pH total score was normal. Conclusions Three kinds of anti-reflux surgery are added for the repair of esophageal hiatal hernia. The curative effect is good. If there is no complicated esophageal stricture and esophageal stenosis, they can be surgically reconstructed and reconstructed with His angle anti-reflux.