食道裂孔疝氣 - 不容忽視的老年人疾病

Abstract

背景:橫膈食道裂孔疝氣是指橫膈膜上食道通過的孔道肌肉退化,導致胃或腹部器官向胸腔推擠。常造成老年人食慾下降、體重減輕;嚴重者有心律不整與呼 吸困難等危及生命之症狀。 目的:探討食道裂孔疝氣類型、臨床表徵與手術預後。 方法:採用病歷回溯方式,調查南部某區域醫院,自 2009 年 6 月至 2019 年 11 月接 受食道裂孔疝氣修補術之個案。 結果:共有 25 位病患接受腹腔鏡輔助剖腹執行食道裂孔疝氣修補,分類以第三型居多有 15(60%)位,平均住院天數 7.4(±5.1)天。術前以胃酸逆流的症狀為 最常見有17位(68%);術後追蹤約三個月後,嘔吐(p <.000)、胃灼熱感(p=.005)、上腹痛(p =.008)以及胃酸逆流(p <.000)等症狀皆達顯著改善。 結論:腹腔鏡輔助剖腹執行食道裂孔疝氣修補,術後住院時間短,病患的生活品質 大幅改善且術後三個月內無裂孔疝氣的復發。  Background: Hiatal hernia (HH) refers to the degeneration of the cruse muscle around the esophagus through the diaphragm, which causes the stomach or abdomi- nal organs to push into the thoracic cavity. It often causes poor appetite and weight loss in the elderly; severe cases even have life-threatening symptoms such as arrhythmia and respiratory distress. Objective: To evaluate the types, clinical manifestations and prognosis of hiatal hernia after laparoscopy-assisted repair of hiatal. Methods: A retrospective study was conducted from June 2009 to November 2019 through medical records to investigate the surgical results of hiatal hernia in a regional hospital of southern Taiwan. Results: A total of 25 patients underwent surgical repair of hiatal hernia, of which 15 (60%) were classified as type III HH. The average hospital stay was 7.4 (±5.1) days. Preoperatively, gastroesophageal reflux symptoms were the most common in 17 patients (68%). Upon postoperative follow-up after more than three months, the symptoms including vomiting (p < .000), heartburn (p = .005), epigastric pain (p = .008), and gastroesophageal reflux (p < .000) were significantly improved. Conclusion: Laparoscopy-assisted laparotomy to perform repair of hiatal hernia can shorten postoperative hospitalization. In a 3-month follow-up period, the patients’quality of life was greatly improved, and there was no recurrence of hiatal hernia within three months after surgery.