CAJ | 학술논문

目的回顾性分析1991年1月至2000年2月经手术治疗的27例先天性食管裂孔疝病例，探讨其诊断、手术适应证、手术入路选择等。方法依据胃肠钡餐造影及术中探查明确诊断及分型。全部病儿均行食管裂孔修补术。21例附加抗反流手术，其中Nissen胃底折叠术17例、Belsey术4例。经左胸入路手术9例、右胸入路3例、经腹15例。结果手术死亡1例，失访3例。23例随访3～84个月，平均21.3个月。1例术后3个月复发，2例经右胸入路手术者有中度胃食管反流，其余效果满意。结论 I型病儿可先试行非手术治疗，其余各型应首先考虑手术。有呕吐及胃食管反流的II型病儿应行抗反流手术。手术入路的选择与合并症有关。
목적회고성분석1991년1월지2000년2월경수술치료적27례선천성식관렬공산병례，탐토기진단、수술괄응증、수술입로선택등。방법의거위장패찬조영급술중탐사명학진단급분형。전부병인균행식관렬공수보술。21례부가항반류수술，기중Nissen위저절첩술17례、Belsey술4례。경좌흉입로수술9례、우흉입로3례、경복15례。결과수술사망1례，실방3례。23례수방3～84개월，평균21.3개월。1례술후3개월복발，2례경우흉입로수술자유중도위식관반류，기여효과만의。결론 I형병인가선시행비수술치료，기여각형응수선고필수술。유구토급위식관반류적II형병인응행항반류수술。수술입로적선택여합병증유관。
Objective: To review the experience of diagnoses and surgical treatment of congenital hiatus hernia. Methods: From January 1991 to Fe bruary 2000, 27 patients with congenital hiatus hernia underwent surgery. The diagnosis was made by barium meal examination. The surgical procedure consisted hernia repair in 27, and anti reflux procedures in 21, Nissen's fundoplication in 17, Belsey's operation in 4. Left thoracic approach was used in 9 cases, right thoracic in 3 and transabdomen in 15. Results: There was 1 operative death. The mean follow -up time was 23.1 months (range, 3 months to 7 years). 1 had recurrence, 2 patients with simple repair had moderate gastroesophageal reflux (GER). The rest of patients were satisfied. Conclusions: Medical treatment may have good response to patients with type I hiatus hernia. For type II patients, surgical treatment should be considered. Addition antireflux surgery should be considered for those patients who have severe vomiting and gastroesophageal reflux. Postoperative complications may related to operative approach.