中国医药导报
中國醫藥導報
중국의약도보
CHINA MEDICAL HERALD
2015年
2期
103-107,112
,共6页
食管裂孔疝%临床表现%辅助检查%误诊
食管裂孔疝%臨床錶現%輔助檢查%誤診
식관렬공산%림상표현%보조검사%오진
Hiatus hernia%Clinical manifestations%Auxiliary examinations%Misdiagnosis
目的：通过对老年食管裂孔疝(hiatus hernia，HH)患者的住院临床资料进行分析，探讨老年HH的临床特征，提高对疾病的认识。方法对1993年3月~2013年3月期间于北京大学第一医院住院的年龄≥65岁，确诊为HH患者进行回顾性分析，收集其性别、年龄、体重指数、确诊周期、主要临床症状、辅助检查方法及其阳性表现、诊断分型、合并症及误诊情况，并对不同检查方法的检出率进行比较。采用SPSS 19.0统计软件进行统计学分析。结果共136例患者入选本研究，年龄65~92岁，平均(75.2±6.6)岁，男65例，女71例(男：女=1：1.09)。52例患者(38.24%)体重指数(BMI)≥24 kg/m2。确诊周期为1 d~20余年。本组患者症状复杂多样，主要症状为反酸烧心(72例，52.94%)、腹痛(49例，36.03%)和恶心呕吐(43例，31.62%)，各临床症状发生率无性别差异(P>0.05)。胸片检查120例，阳性29例(24.17%)；上消化道造影67例，阳性61例(91.04%)；胃镜80例，阳性72例(90.00%)；胸/腹部CT 76例，阳性46例(60.53%)。上消化道造影、胃镜、CT检出率高于胸片(P<0.05)；胃镜检出率高于CT(P<0.05)；上消化道造影与胃镜、上消化道造影与CT的检出率差异无统计学意义(P>0.05)。115例患者分型明确，其中101例为Ⅰ型(87.83%)，6例为Ⅱ型，1例为Ⅲ型，7例为Ⅳ型。共有115例接受上消化道造影和/或胃镜检查，其中64例检出合并胃食管反流病(GERD)(55.65%)，男性组与女性组之间差异无统计学意义(P>0.05)。误诊12例(8.82%)，分别被误诊为冠心病(8例)，食管癌(2例)，肺部占位(1例)，胃溃疡(1例)。结论老年HH患病无明显性别差异，其症状复杂多样，病程长，确诊周期长；最主要症状为反酸烧心、腹痛及恶心呕吐，各症状发生率无明显性别差异；Ⅳ型HH最为常见；上消化道造影和胃镜检出率较高，不同检查方法各有利弊，可互相补充；老年患者HH症状不特异也不典型，容易造成误诊。
目的：通過對老年食管裂孔疝(hiatus hernia，HH)患者的住院臨床資料進行分析，探討老年HH的臨床特徵，提高對疾病的認識。方法對1993年3月~2013年3月期間于北京大學第一醫院住院的年齡≥65歲，確診為HH患者進行迴顧性分析，收集其性彆、年齡、體重指數、確診週期、主要臨床癥狀、輔助檢查方法及其暘性錶現、診斷分型、閤併癥及誤診情況，併對不同檢查方法的檢齣率進行比較。採用SPSS 19.0統計軟件進行統計學分析。結果共136例患者入選本研究，年齡65~92歲，平均(75.2±6.6)歲，男65例，女71例(男：女=1：1.09)。52例患者(38.24%)體重指數(BMI)≥24 kg/m2。確診週期為1 d~20餘年。本組患者癥狀複雜多樣，主要癥狀為反痠燒心(72例，52.94%)、腹痛(49例，36.03%)和噁心嘔吐(43例，31.62%)，各臨床癥狀髮生率無性彆差異(P>0.05)。胸片檢查120例，暘性29例(24.17%)；上消化道造影67例，暘性61例(91.04%)；胃鏡80例，暘性72例(90.00%)；胸/腹部CT 76例，暘性46例(60.53%)。上消化道造影、胃鏡、CT檢齣率高于胸片(P<0.05)；胃鏡檢齣率高于CT(P<0.05)；上消化道造影與胃鏡、上消化道造影與CT的檢齣率差異無統計學意義(P>0.05)。115例患者分型明確，其中101例為Ⅰ型(87.83%)，6例為Ⅱ型，1例為Ⅲ型，7例為Ⅳ型。共有115例接受上消化道造影和/或胃鏡檢查，其中64例檢齣閤併胃食管反流病(GERD)(55.65%)，男性組與女性組之間差異無統計學意義(P>0.05)。誤診12例(8.82%)，分彆被誤診為冠心病(8例)，食管癌(2例)，肺部佔位(1例)，胃潰瘍(1例)。結論老年HH患病無明顯性彆差異，其癥狀複雜多樣，病程長，確診週期長；最主要癥狀為反痠燒心、腹痛及噁心嘔吐，各癥狀髮生率無明顯性彆差異；Ⅳ型HH最為常見；上消化道造影和胃鏡檢齣率較高，不同檢查方法各有利弊，可互相補充；老年患者HH癥狀不特異也不典型，容易造成誤診。
목적：통과대노년식관렬공산(hiatus hernia，HH)환자적주원림상자료진행분석，탐토노년HH적림상특정，제고대질병적인식。방법대1993년3월~2013년3월기간우북경대학제일의원주원적년령≥65세，학진위HH환자진행회고성분석，수집기성별、년령、체중지수、학진주기、주요림상증상、보조검사방법급기양성표현、진단분형、합병증급오진정황，병대불동검사방법적검출솔진행비교。채용SPSS 19.0통계연건진행통계학분석。결과공136례환자입선본연구，년령65~92세，평균(75.2±6.6)세，남65례，녀71례(남：녀=1：1.09)。52례환자(38.24%)체중지수(BMI)≥24 kg/m2。학진주기위1 d~20여년。본조환자증상복잡다양，주요증상위반산소심(72례，52.94%)、복통(49례，36.03%)화악심구토(43례，31.62%)，각림상증상발생솔무성별차이(P>0.05)。흉편검사120례，양성29례(24.17%)；상소화도조영67례，양성61례(91.04%)；위경80례，양성72례(90.00%)；흉/복부CT 76례，양성46례(60.53%)。상소화도조영、위경、CT검출솔고우흉편(P<0.05)；위경검출솔고우CT(P<0.05)；상소화도조영여위경、상소화도조영여CT적검출솔차이무통계학의의(P>0.05)。115례환자분형명학，기중101례위Ⅰ형(87.83%)，6례위Ⅱ형，1례위Ⅲ형，7례위Ⅳ형。공유115례접수상소화도조영화/혹위경검사，기중64례검출합병위식관반류병(GERD)(55.65%)，남성조여녀성조지간차이무통계학의의(P>0.05)。오진12례(8.82%)，분별피오진위관심병(8례)，식관암(2례)，폐부점위(1례)，위궤양(1례)。결론노년HH환병무명현성별차이，기증상복잡다양，병정장，학진주기장；최주요증상위반산소심、복통급악심구토，각증상발생솔무명현성별차이；Ⅳ형HH최위상견；상소화도조영화위경검출솔교고，불동검사방법각유리폐，가호상보충；노년환자HH증상불특이야불전형，용역조성오진。
Objective To investigate the clinical characteristics of patients with hiatus hernia (HH) by analyzing the clinical data of elderly inpatients. Methods Inpatients admitted into Peking University First Hospital during March 1993 to March 2013 diagnosed as HH and elder than 65 were analyzed retrospectively. Gender, age, body mass index, diagnostic interval, main symptoms, auxiliary examination methods and manifestations, clinical subtypes, complications and misdiagnosis were collected and analyzed. The detection rates were compared between different modalities. SPSS 19.0 was used for statistical analysis. Results 136 patients were enrolled into the study. Aged from 65-92, the mean age was (75.2±6.6) years. 65 males and 71 females was 1:1.09. 52 patients (38.24%) were overweight or obese (BMI≥24 kg/m2). The diagnostic interval varied from 1 day to more than 20 years. These patients had various clinical manifes-tations and their main symptoms were acid regurgitation and heartburn (72 cases, 52.94%), abdominal pain (49 cases, 36.03%) and nausea and vomiting (43 cases, 31.62%). There were no differences in the incidence of symptom between male and female (P>0.05). 29 cases (29/120, 24.17%) had positive chest X-ray results, and 61 cases (61/67, 91.04%) for upper gastrointestinal videofluorography, 72 cases (72/80, 90.00%) for EGD, 46 cases (46/76, 60.53%) for chest/ab-dominal CT scan. The detection rates of videofluorography, EGD and CT were superior to chest X-ray (P< 0.05) and EGD superior to CT (P<0.05). There were no differences in the detection rates between videofluorography and EGD or CT (P> 0.05). Among the 115 patients who could be identified types, 101 cases were type Ⅰ (87.83%), 6 cases were typeII, 1 case was typeⅢ, 7 cases were typeⅣ. 64 patients (64/115, 55.65%) who underwent videofluorography and/or EGD were complicated with GERD. There were no differences in the GERD between male and female (P>0.05). 12 patients (8.82%) were misdiagnosed, namely, coronary heart disease (8 cases), esophageal cancer (2 cases), lung mass (1 case) and gastric ulcer(1 case). Conclusion The el-derly patients with HH have no gender difference. They have complicated various symptoms, long durations and diag-nostic intervals. Their main symptoms are acid regurgitation and heartburn, abdominal pain, nausea and vomiting and without gender difference in symptoms. The most common type is type Ⅰ. Videofluorography and EGD have higher de-tection rates but each modality possesses its own advantages and disadvantages, thus they can complement each other. The atypical and non-specific symptoms of elderly patients with HH result in high misdiagnosis rate.
