切换至 "中华医学电子期刊资源库"

中华疝和腹壁外科杂志(电子版) ›› 2026, Vol. 20 ›› Issue (03) : 351 -356. doi: 10.3877/cma.j.issn.1674-392X.2026.03.020

综述

合并吞咽困难的食管裂孔疝诊疗策略:基于病因机制的分型与个体化治疗
吴星宇, 韩海峰, 逯景辉()   
  1. 250012 济南,山东大学齐鲁医院普外科疝与腹壁外科
  • 收稿日期:2026-04-22 出版日期:2026-06-18
  • 通信作者: 逯景辉

Diagnostic and therapeutic strategies for hiatal hernia with dysphagia: Etiology-based classification and individualized treatment

Xingyu Wu, Haifeng Han, Jinghui Lu()   

  1. Department of Hernia and Abdominal Wall Surgery, Department of General Surgery, Qilu Hospital of Shandong University, Jinan 250012, China
  • Received:2026-04-22 Published:2026-06-18
  • Corresponding author: Jinghui Lu
引用本文:

吴星宇, 韩海峰, 逯景辉. 合并吞咽困难的食管裂孔疝诊疗策略:基于病因机制的分型与个体化治疗[J/OL]. 中华疝和腹壁外科杂志(电子版), 2026, 20(03): 351-356.

Xingyu Wu, Haifeng Han, Jinghui Lu. Diagnostic and therapeutic strategies for hiatal hernia with dysphagia: Etiology-based classification and individualized treatment[J/OL]. Chinese Journal of Hernia and Abdominal Wall Surgery(Electronic Edition), 2026, 20(03): 351-356.

吞咽困难是食管裂孔疝重要而复杂的临床表现,其发生并非均由单纯机械性梗阻所致,还与食管动力障碍、反流相关炎性狭窄、食管憩室及结缔组织病等因素密切相关。本文结合相关文献及临床实践,对合并吞咽困难的食管裂孔疝进行病因机制梳理,重点总结胃镜、上消化道造影、高分辨率食管测压、24 h pH阻抗监测及食管胃连接部充盈超声造影等检查在"结构—功能一体化"评估中的作用,并归纳不同病因导向下的治疗策略。我们认为该类患者应在精准识别主导机制的基础上实施个体化诊疗,合理把握扩张、抗反流治疗、食管裂孔疝修补及相关功能性手术的适应证,以改善吞咽困难症状和整体预后。

Dysphagia is an important and complex manifestation of hiatal hernia and is not always caused by simple mechanical obstruction. It may also be related to esophageal motility disorders, reflux-related inflammatory strictures, esophageal diverticula, and connective tissue diseases. Based on the relevant literature and clinical practice, this article reviews the etiological mechanisms of hiatal hernia complicated by dysphagia, mainly summarizes the roles of gastroscopy, upper gastrointestinal contrast study, high-resolution esophageal manometry, 24-hour pH-impedance monitoring, and esophagogastric junction filling ultrasound contrast imaging in the integrated assessment of structure and function, and outlines etiology-oriented treatment strategies. We believe that for such patients, individualized management should be guided by accurate identification of the dominant mechanism so as to reasonably optimize the indications for dilation, anti-reflux therapy, hiatal hernia repair, and related functional procedures, thereby improving dysphagia and overall prognosis.

图1 本中心诊治的1例食管裂孔疝合并Ⅱ型贲门失弛缓症患者的术前检查 1A CT示右侧膈肌左右支及上移的食管胃连接部;1B 上消化道造影示食管近端扩张、末端鸟嘴样改变;1C HRM示LES和膈肌脚高压区分离,提示食管裂孔疝,同时可见吞咽后较均匀的全食管加压,符合Ⅱ型贲门失弛缓症表现注:HRM为高分辨率食管测压,LES为食管下括约肌。
图2 1例食管裂孔疝合并巨大膈上食管憩室患者的术前检查[30] 2A CT示膈肌上食管憩室内可见胃管;2B CT示右侧膈肌脚左右支及疝出的胃底;2C上消化道造影示食管下段多发憩室,以左侧为著
图3 本中心诊治的1例系统性硬化症(硬皮病)累及食管患者的影像学表现 3A CT示扩张的食管内充满大量食物残渣;3B CT示右侧膈肌脚及轻微扩大的食管裂孔;3C上消化道造影示食管下段囊样扩张及排空异常
[1]
Dr. Bowditch’s Memoir on Diaphragmatic Hernia[J]. Buffalo Med J Mon Rev Med Surg Sci, 1853, 9(1): 64.
[2]
Barrett NR. Hiatus hernia: a review of some controversial points[J]. Br J Surg, 1954, 42(173): 231-243.
[3]
Han H, Zhao M, Yang S, et al. Laparoscopic repair of parahiatal hernia: surgical techniques and literature reviews[J]. Hernia, 2025, 29(1): 85.
[4]
Ceron REC, Yates RB, Wright AS, et al. Type II hiatal hernias: do they exist or are they actually parahiatal hernias?[J]. Surg Endosc, 2023, 37(3): 1956-1961.
[5]
Maziak DE, Todd TR, Pearson FG. Massive hiatus hernia: evaluation and surgical management[J]. J Thorac Cardiovasc Surg, 1998, 115(1): 53-60; discussion 61-62.
[6]
Kaul BK, Demeester TR, Oka M, et al. The cause of dysphagia in uncomplicated sliding hiatal hernia and its relief by hiatal herniorrhaphy. A roentgenographic, manometric, and clinical study [J]. Ann Surg, 1990, 211(4): 406-410.
[7]
Williams JL. Gastroesophageal reflux disease: clinical manifestations [J]. Gastroenterol Nurs, 2003, 26(5): 195-200.
[8]
Gyawali CP, Carlson DA, Chen JW, et al. ACG Clinical Guidelines: Clinical Use of Esophageal Physiologic Testing[J]. Am J Gastroenterol, 2020, 115(9): 1412-1428.
[9]
Weijenborg PW, Van Hoeij FB, Smout AJPM, et al. Accuracy of hiatal hernia detection with esophageal high-resolution manometry [J]. Neurogastroenterol Motil, 2015, 27(2): 293-299.
[10]
Khajanchee YS, Cassera MA, Swanström LL, et al. Diagnosis of Type-I hiatal hernia: a comparison of high-resolution manometry and endoscopy[J]. Dis Esophagus, 2013, 26(1): 1-6.
[11]
Herregods TVK, Roman S, Kahrilas PJ, et al. Normative values in esophageal high-resolution manometry[J]. Neurogastroenterol Motil, 2015, 27(2): 175-187.
[12]
Yadlapati R, Kahrilas PJ, Fox MR, et al. Esophageal motility disorders on high-resolution manometry: Chicago classification version 4. 0©[J]. Neurogastroenterol Motil, 2021, 33(1): e14058.
[13]
马宁, 蒋清凌, 刘广健, 等. 应用食管胃结合部充盈超声造影对食管裂孔疝诊断和术后随访价值研究[J]. 中国实用外科杂志, 2025, 45(4): 465-468.
[14]
Tucker E, Sweis R, Anggiansah A, et al. Measurement of esophago-gastric junction cross-sectional area and distensibility by an endolumenal functional lumen imaging probe for the diagnosis of gastro-esophageal reflux disease[J]. Neurogastroenterol Motil, 2013, 25(11): 904-910.
[15]
Carlson DA, Lin Z, Kahrilas PJ, et al. The Functional Lumen Imaging Probe Detects Esophageal Contractility Not Observed With Manometry in Patients With Achalasia[J]. Gastroenterology, 2015, 149(7): 1742-1751.
[16]
Pandolfino JE, Kwiatek MA, Ho K, et al. Unique features of esophagogastric junction pressure topography in hiatus hernia patients with dysphagia[J]. Surgery, 2010, 147(1): 57-64.
[17]
郑铭, 鄂一民, 陆晨, 等. 胃食管反流病发生的解剖学基础及手术治疗策略[J]. 中华消化外科杂志, 2024, 23(11): 1465-1470.
[18]
Hanna NM, Kumar SS, Collings AT, et al. Management of symptomatic, asymptomatic, and recurrent hiatal hernia: a systematic review and meta-analysis[J]. Surg Endosc, 2024, 38(6): 2917-2938.
[19]
Ott DJ, Hodge RG, Chen MY, et al. Achalasia associated with hiatal hernia: prevalence and potential implications[J]. Abdom Imaging, 1993, 18(1): 7-9.
[20]
Goldenberg SP, Vos C, Burrell M, et al. Achalasia and hiatal hernia[J]. Dig Dis Sci, 1992, 37(4): 528-531.
[21]
Tutuian G, Leandri C, Tutuian R, et al. Achalasia and Hiatal Hernia: A Rare Association and a Therapeutic Challenge[J]. J Neurogastroenterol Motil, 2023, 29(4): 455-459.
[22]
Slater BJ, Collings A, Dirks R, et al. Multi-society consensus conference and guideline on the treatment of gastroesophageal reflux disease(GERD)[J]. Surg Endosc, 2023, 37(2): 781-806.
[23]
Nikolic M, Schwameis K, Kristo I, et al. Ineffective Esophageal Motility in Patients with GERD is no Contraindication for Nissen Fundoplication[J]. World J Surg, 2020, 44(1): 186-193.
[24]
Yamasaki Y, Ozawa S, Oguma J, et al. Long peptic strictures of the esophagus due to reflux esophagitis: a case report[J]. Surg Case Rep, 2016, 2(1): 64.
[25]
中华医学会消化病学分会. 2020年中国胃食管反流病专家共识[J]. 中华消化杂志, 2020, 40(10): 649-663.
[26]
Kohn GP, Price RR, Demeester SR, et al. Guidelines for the management of hiatal hernia[J]. Surg Endosc, 2013, 27(12): 4409-4428.
[27]
Sami SS, Haboubi HN, Ang Y, et al. UK guidelines on oesophageal dilatation in clinical practice[J]. Gut, 2018, 67(6): 1000-1023.
[28]
Smith CD. Esophageal strictures and diverticula[J]. Surg Clin North Am, 2015, 95(3): 669-681.
[29]
Brandeis AE, Singhal S, Lee TH, et al. Surgical management of epiphrenic diverticulum: A single-center experience and brief review of literature[J]. Am J Surg, 2018, 216(2): 280-285.
[30]
Zhao MJ, Li RW, Lu JH. Treatment of giant lower esophageal diverticulum using laparoscopic surgery[J]. Asian J Surg, 2024, S1015-9584(24)01892-X.
[31]
Luquez-Mindiola A, Atuesta AJ, Gómez-Aldana AJ. Gastrointestinal manifestations of systemic sclerosis: An updated review[J]. World J Clin Cases, 2021, 9(22): 6201-6217.
[32]
Denaxas K, Ladas SD, Karamanolis GP. Evaluation and management of esophageal manifestations in systemic sclerosis[J]. Ann Gastroenterol, 2018, 31(2): 165-170.
[33]
Kaniecki T, Hughes M, Mcmahan Z. Managing gastrointestinal manifestations in systemic sclerosis, a mechanistic approach[J]. Expert Rev Clin Immunol, 2024, 20(6): 603-622.
[1] 杨志, 夏雪峰, 管文贤. DeepSurv深度学习模型辅助胃癌术后精准化疗策略研究[J/OL]. 中华普外科手术学杂志(电子版), 2025, 19(05): 501-505.
[2] 李瑞芳, 王明帅, 邢念增. 循环肿瘤细胞在膀胱癌诊断和预后中的应用进展[J/OL]. 中华腔镜泌尿外科杂志(电子版), 2025, 19(06): 705-713.
[3] 马宁, 周太成, 陈双. 食管裂孔疝手术并发症的预防与处理:以单中心经验为核心的实践策略[J/OL]. 中华疝和腹壁外科杂志(电子版), 2026, 20(03): 253-258.
[4] 鲁丁维, 郭洪瑞, 刘迪, 毛显龙, 易泓霖, 王汝娟, 邹春莉, 李鹏. 3+2+1解剖缝合策略在完全机器人食管裂孔疝修补+胃底折叠术中的临床应用[J/OL]. 中华疝和腹壁外科杂志(电子版), 2026, 20(03): 265-271.
[5] 李赞林, 祖母乃提·玉山, 艾克拜尔·艾力, 克力木·阿不都热依木, 李义亮. 机器人3+1模式在食管裂孔疝修补术中的应用体会[J/OL]. 中华疝和腹壁外科杂志(电子版), 2026, 20(03): 272-276.
[6] 蔡理全, 张金龙, 高训锋, 余丹, 张金辉, 张恒. 腹腔镜食管裂孔疝修补术中保留迷走神经肝支的可行性及安全性[J/OL]. 中华疝和腹壁外科杂志(电子版), 2026, 20(03): 277-283.
[7] 傅晓键, 黄先觉, 储宇霄, 朱志远, 姚琪远, 花荣. 腹腔镜合成补片修补Ⅲ型食管裂孔疝的中期疗效分析:单中心回顾性研究[J/OL]. 中华疝和腹壁外科杂志(电子版), 2026, 20(03): 284-288.
[8] 马建惠, 白洁, 赵叶, 张丽. 奥瑞姆自护理论干预模式在食管裂孔疝术后患者中的应用效果[J/OL]. 中华疝和腹壁外科杂志(电子版), 2026, 20(03): 289-295.
[9] 张皓程, 陈明豪, 刘宾, 万方鑫, 李宝玉. 腹腔镜食管裂孔疝术后并发食管胸膜腔瘘一例分析[J/OL]. 中华疝和腹壁外科杂志(电子版), 2026, 20(02): 238-240.
[10] 田书瑞, 李冉, 胡志伟, 吴继敏. 不同体位对滑动型食管裂孔疝滑动的影响[J/OL]. 中华疝和腹壁外科杂志(电子版), 2025, 19(06): 684-688.
[11] 钟文卿, 韩冰. 基于术前CT影像数据构建肝癌患者生存期Nomogram预测模型[J/OL]. 中华肝脏外科手术学电子杂志, 2026, 15(01): 53-58.
[12] 李建波, 李易, 尹万红, 康焰. 感染性休克早期关键治疗策略的EFSP框架[J/OL]. 中华重症医学电子杂志, 2026, 12(01): 1-6.
[13] 余绍斌, 康明强. ⅠA3期非小细胞肺癌预后差异及治疗策略研究进展[J/OL]. 中华胸部外科电子杂志, 2026, 13(02): 132-139.
[14] 中国医师协会外科医师分会胃食管反流疾病诊疗外科专家工作组青年委员会, 广东省医学会疝与腹壁外科学分会, 广东省科技成果转化促进会和广东省全民大健康发展研究院共建胃肠疝腹壁分会, 广东省医师协会疝与腹壁外科医师分会食管裂孔疝和胃食管反流性疾病工作组, 中国疝外科学院. 食管裂孔疝有关抗反流手术术前检查专家共识(2026版)[J/OL]. 中华胃食管反流病电子杂志, 2026, 13(01): 1-7.
[15] 刘晓辉, 罗峰, 卢顺安, 张正雄, 杨荣松, 字焱斌, 李鹏. 基层医院腹腔镜手术治疗食管裂孔疝合并胃食管反流病患者46例临床分析[J/OL]. 中华胃食管反流病电子杂志, 2026, 13(01): 25-30.
阅读次数
全文


摘要


AI


AI小编
你好!我是《中华医学电子期刊资源库》AI小编,有什么可以帮您的吗?