目的

探讨不同检查方法对巨大食管裂孔疝（GHH）合并胃食管反流病的诊断价值及各检查指标间的相关性。

方法

纳入2022 年1 月至2023 年12 月，新疆维吾尔自治区人民医院微创外科、疝与腹壁外科收治的44 例GHH 患者，回顾性分析其术前各项检查结果[胃镜、腹部CT、高分辨率食管测压（HREM）、食管动态24 h pH 监测]。并据DeMeester 评分和胃食管反流病问卷量表（Gerd Q）评分将患者分为反流组[合并GERD，即DeMeester 评分≥14.72，Gerd Q 评分≥8] 27例，非反流组（不合并GERD，即DeMeester 评分＜14.72，Gerd Q 评分＜8） 17 例。进一步分析不同检查指标在2组患者中的差异及对GHH 合并GERD 的诊断价值。

结果

Pearson 相关性分析得出，腹部CT检查的HH横径与疝囊容积、HREM的HH直径正相关（R=0.502，P=0.001；R=0.357，P=0.017）；DeMeester 评分与Gerd Q 评分、腹部CT 检查的HH 横径均呈正相关（R=0.422，P=0.004；R=0.372，P=0.013）；食管下括约肌静息压（LESP）与Gerd Q 评分，胃镜检查胃食管阀瓣（GEFV）的Hill分级，腹部CT 检查的HH 横径、疝囊容积，HREM 所得HH 直径，DeMeester 评分均无相关性。反流组与非反流组比较仅Gerd Q 评分较高，差异有统计学意义（t=2.424，P=0.02）；上消化道造影、腹部CT 检查的HH 横径、疝囊容积、LESP、胃镜GEFV 的Hill 分级、HREM 的HH 直径比较，差异均无统计学意义（P＞0.05）。受试者工作特征曲线（ROC）显示上消化道造影（AUC=0.500，P=1.000）、胃镜检查GEFV 的Hill 分级（AUC=0.572，P=0.426，敏感度40.7%，特异度76.5%）、腹部CT 检查的疝囊容积（AUC=0.516，P=0.857，敏感度92.6%，特异度29.4%）、HH 横径（AUC=0.661，P=0.074，敏感度100%，特异度35.3%）、LESP（AUC=0.422，P =0.386，敏感度22.2%，特异度82.4%）、HREM 的HH 直径（AUC=0.601，P =0.262，敏感度55.6%，特异度76.5%）、Gerd Q 评分（AUC=0.714，P=0.018，敏感度66.7%，特异度70.6%）。

结论

HH 横径及Gerd Q 评分对诊断GHH 合并GERD 价值较高，而LESP 降低不是GHH 的决定性的因素，测压作用主要是排除食管动力障碍性疾病，对GHH 合并GERD 的诊断价值不高。

Objective

To explore the diagnostic value of different examination methods for giant hiatal hernia (GHH) complicated with gastroesophageal reflux disease (GERD) and the correlation between the examination indexes.

Methods

A total of 44 patients with GHH admitted to Minimally Invasive Surgery, Hernia and Abdominal Wall Surgery in the People's Hospital of Xinjiang Uygur Autonomous Region from January 2022 to December 2023 were included, and the preoperative examination results [gastroscopy, abdominal CT, high-resolution esophageal manometry (HREM),dynamic esophageal pH monitoring for 24h] were retrospectively analyzed. According to DeMeester score and Gerd Q score, 27 patients were divided into reflux group [combined GERD, DeMeester score ≥14.72,Gerd Q score ≥8], and non-reflux group (without GERD, DeMeester score＜14.72, Gerd Q score＜8), 17 cases. Further analysis was made on the difference of different examination indexes in the two groups and the diagnostic value of GHH combined with GERD.

Results

Pearson correlation analysis showed that the transverse diameter of HH examined by abdominal CT was positively correlated with the volume of hernia sac and HH diameter of HREM (R=0.502, P=0.001; R=0.357, P=0.017); the DeMeester score was positively correlated with the Gerd Q score and HH transverse diameter of abdominal CT examination(R=0.422, P=0.004; R=0.372, P=0.013); Lower esophageal sphincter rest pressure（LESP） had no correlation with the Gerd Q score, Hill grade of GEFV in gastroscopy, volume of herniated sac, transverse diameter of HH in abdominal CT, diameter of HH in HREM, and DeMeester score. Only the Gerd Q score of the reflux group was higher than that of the non-reflux group, and the difference was statistically significant (t=2.424, P=0.020). There were no significant differences in the transverse diameter of HH,LESP, Hill grade of GEFV by gastroscopy, volume of herniated sac and HH diameter of HREM by upper digestive tract angiography and abdominal CT (P＞0.05). Receiver operating characteristic curve (ROC)obtained upper gastrointestinal angiography (AUC=0.500, P=1.000), Hill grade of GEFV in gastroscopy(AUC=0.572, P=0.426, sensitivity 40.7%, specificity 76.5%), and hernial sac volume in abdominal CT examination (AUC=0.516, P=0.857, sensitivity 92.6%, specificity 29.4%), HH transverse diameter(AUC=0.661, P=0.074, sensitivity 100%, specificity 35.3%), LESP (AUC=0.422, P=0.386, sensitivity 22.2%, specificity 82.4%), HH diameter of HREM (AUC=0.601, P=0.262, sensitivity 55.6%, specificity 76.5%); Gerd Q score (AUC=0.714, P=0.018, sensitivity 66.7%, specificity 70.6%).

Conclusion

HH transverse diameter and Gerd Q score are of high value in the diagnosis of GHH combined with GERD,while the decrease of LESP is not a decisive factor in GHH. The manometry is mainly to exclude esophageal motility disorders, and is not of high value in the diagnosis of GHH combined with GERD.