Clinical diagnosis and treatment of children with congenital esophageal hiatal hernia

doi:10.3877/cma.j.issn.1673-5250.2024.01.005

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

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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