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中华妇幼临床医学杂志(电子版)

中华妇幼临床医学杂志(电子版) ›› 2024, Vol. 20 ›› Issue (01) : 32 -38. doi: 10.3877/cma.j.issn.1673-5250.2024.01.005

先天性膈疝专辑

先天性食管裂孔疝患儿临床诊疗研究
徐慧姣1, 陈佳俊1, 赖冠宇1, 蒋琴1, 马俊梅1, 侯昉1, 刘文英1,†(), 徐冰1,†()   
  1. 1. 电子科技大学附属医院·四川省人民医院小儿外科，成都　610072
  • 收稿日期:2023-10-22 修回日期:2024-01-11 出版日期:2024-02-01
  • 通信作者: 刘文英, 徐冰

Clinical diagnosis and treatment of children with congenital esophageal hiatal hernia

Huijiao Xu1, Jiajun Chen1, Guanyu Lai1, Qin Jiang1, Junmei Ma1, Fang Hou1, Wenying Liu1,†(), Bing Xu1,†()   

  1. 1. Department of Pediatric Surgery, Sichuan Provincial People′s Hospital, University of Electronic Science & Technology of China, Chengdu 610072, Sichuan Province, China
  • Received:2023-10-22 Revised:2024-01-11 Published:2024-02-01
  • Corresponding author: Wenying Liu, Bing Xu
  • Supported by:
    Sichuan Province Tianfu Talent Plan, Tianfu Famous Physicians Project(TF005); Project of Key Research and Development by Science & Technology Department of Sichuan Province(2021YFS0381); Specialized Project by Sichuan Academy of Medical Sciences·Sichuan Provincial People′s Hospital(2021ZX03)
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徐慧姣, 陈佳俊, 赖冠宇, 蒋琴, 马俊梅, 侯昉, 刘文英, 徐冰. 先天性食管裂孔疝患儿临床诊疗研究[J]. 中华妇幼临床医学杂志(电子版), 2024, 20(01): 32-38.

Huijiao Xu, Jiajun Chen, Guanyu Lai, Qin Jiang, Junmei Ma, Fang Hou, Wenying Liu, Bing Xu. Clinical diagnosis and treatment of children with congenital esophageal hiatal hernia[J]. Chinese Journal of Obstetrics & Gynecology and Pediatrics(Electronic Edition), 2024, 20(01): 32-38.

目的

探讨先天性食管裂孔疝(EHH)患儿的临床诊断及手术治疗方法。

方法

选择2010年6月至2023年4月于电子科技大学附属医院·四川省人民医院小儿外科采取腹腔镜下EHH修补术＋胃底悬吊固定术治疗的18例先天性EHH患儿(患儿1～18)为研究对象。其中，男性患儿为15例(患儿1～7、9～10、12～13、15～18)，女性为3例(患儿8、11、14)；平均年龄为4岁6个月(6 d至18岁2个月)；产前胎儿超声辅助诊断先天性EHH为2例(患儿9、15)，其余16例(患儿1～8、10～14、16～18)采取上消化道X射线造影检查、胸部CT及胃镜检查被确诊。本研究符合2013年修订的《世界医学协会赫尔辛基宣言》相关要求。所有患儿监护人了解患儿的诊疗过程，并签署临床研究知情同意书。

结果

本组18例患儿(患儿1～18)均顺利完成手术，手术时间为(45.0±15.3)min，术中出血量为(15.0±5.4) mL；术后无一例发生手术相关严重并发症；17例患儿(患儿1～17)术后恢复较好，并顺利出院，1例(患儿18)于术后第3天因经济原因自动出院，结局不详。参与术后随访的17例患儿(患儿1～17)中，16例患儿(患儿1～10、12～17)手术疗效为治愈，1例(患儿11)为有效；14例患儿(患儿1～14)完成中-长期随访，中位随访时间为78个月。

结论

腹腔镜下先天性EHH修补术＋胃底悬吊固定术，对于治疗先天性EHH患儿安全、简便，术后胃食管反流(GER)及食管狭窄等并发症少，EHH复发率低，患儿中-长期随访结果较好。

关键词: 胃底折叠术, 疝，食管裂孔, 腹腔镜, 疝修补术, 胃食管反流, 食管狭窄, 儿童
Objective

To investigate the clinical diagnosis and surgical treatment of congenital esophageal hiatal hernia (EHH) in children.

Methods

From June 2010 to April 2023, 18 children with congenital EHH (child 1-18) who were treated by laparoscopic EHH repair + fundus suspension fixation in Sichuan Provincial People′s Hospital, University of Electronic Science & Technology of China were selected as the study subjects. Among them, 15 cases were male (child 1-7, 9-10, 12-13, 15-18) and 3 cases were female (child 8, 11, 14). The mean age was 4 years and 6 months (6 days to 18 years and 2 months). Prenatal fetal ultrasonography assisted diagnosis of congenital EHH in 2 cases (child 9, 15), the remaining 16 cases (child 1-8, 10-14, 16-18) were confirmed by upper digestive tract X-ray examination, chest CT examination and gastroscopy. The study protocol was performed in accordance with the Helsinki Declaration of the World Medical Association revised in 2013, and informed consents of clinical research were obtained from guardians of all participants.

Results

All 18 patients (child 1-18) successfully completed the operation, the operation time was (45.0±15.3) min, the intraoperative blood loss was (15.0±5.4) mL. No serious complications occurred after operation. Seventeen patients (child 1-17) recovered well after surgery and were discharged successfully. One patient (child 18) was discharged automatically on the third day after surgery due to economic reasons, with an unknown outcome. After the operation, 17 children (child 1-17) participated in the follow-up, 16 children (child 1-10, 12-17) were cured, and 1 child (child 11) was effective. Fourteen patients (child 1-14) completed medium to long-term follow-up, with a median follow-up time of 78 months.

Conclusions

Laparoscopic congenital EHH repair combined with fundus suspension is safe and simple for the treatment of children with congenital EHH, with fewer postoperative complications such as gastroesophageal reflux (GER) and esophageal stenosis, low recurrence rate of EHH, and good results of medium to long-term follow-up.

Key words: Fundoplication, Hernia, hiatal, Laparoscopes, Herniorrhaphy, Gastroesophageal reflux, Esophageal stenosis, Child
图1 先天性EHH患儿4(男性，270 d龄)EHH术前、后上消化道X射线造影图(图1A：可见左侧肺下叶受压，胃疝入左侧胸腔；图1B：可见胃已回纳至腹腔，恢复至正常解剖位置)注：EHH为食管裂孔疝
表1 本组18例先天性EHH患儿临床资料比较
患儿编号 性别 手术年龄 确诊检查 临床症状 手术时间(min) 术中出血量(mL) 术后恢复进食时间(d) 术后住院时间(d)
1 男 4岁 GI＋胸部X射线摄片 呕吐 42 14 2 6
2 男 7岁 GI＋胸部CT 呕吐 45 12 1 6
3 男 2岁 GI＋胸部X射线摄片 呕吐 32 10 2 7
4 男 270 d GI＋胸部X射线摄片 咳嗽 32 15 3 10
5 男 18岁 GI＋胸部CT 呕吐 29 25 1 4
6 男 1岁 GI＋胸部X射线摄片 呕吐 45 13 2 7
7 男 128 d GI＋胸部X射线摄片 呕吐 50 12 3 6
8 女 347 d GI＋胸部X射线摄片 呕吐 67 11 2 9
9 男 6 d 产前胎儿超声 饮奶呛咳、呕吐 55 10 3 7
10 男 1岁 GI＋胸部X射线摄片 呕吐 66 14 2 10
11 女 5岁 GI＋胸部CT 呕吐 75 28 3 9
12 男 11岁 GI＋胸部CT 反酸、嗳气 42 10 1 5
13 男 18岁 GI＋胸部CT 反酸、嗳气、胸骨后疼痛 28 22 1 4
14 女 237 d GI＋胸部X射线摄片 呕吐 30 12 2 9
15 男 144 d GI＋胸部X射线摄片 饮奶呛咳、呕吐 35 15 3 9
16 男 1岁 GI＋胸部X射线摄片 呕吐 40 19 2 9
17 男 3岁 GI＋胸部X射线摄片 呕吐 29 18 2 6
18 男 6 d 产前胎儿超声 饮奶呛咳、呕吐 68 10 3 3
表2 本组参与中-长期随访的14例先天性EHH患儿的随访结果比较
患儿编号 性别 手术年龄 随访时间(月) 术后疗效 身高(cm)a 体重(kg)a 性格 SAS评分(分) SDS评分(分)
1 男 4岁 120 治愈 175 60 内向 37 42
2 男 7岁 108 治愈 178 65 外向 35 38
3 男 2岁 72 治愈 130 26 外向 34 34
4 男 270 d 60 治愈 115 20 外向 32 32
5 男 18岁 120 治愈 170 50 外向 46 48
6 男 1岁 72 治愈 120 22 外向 28 32
7 男 128 d 108 治愈 121 25 外向 32 35
8 女 347 d 120 治愈 150 40 外向 37 28
9 男 6 d 60 治愈 112 18 外向 30 36
10 男 1岁 84 治愈 130 45 外向 40 31
11 女 5岁 72 有效 110 20 外向 47 45
12 男 11岁 60 治愈 173 61 外向 44 37
13 男 18岁 120 治愈 165 60 外向 49 48
14 女 237 d 60 治愈 115 20 外向 30 27
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