分析抗反流手术患者食管裂孔疝（HH）的术前检出情况及其相关因素，并比较食管钡剂造影、上消化道内镜和胸腹部CT在术中证实HH患者中的报告检出比例。

采用单中心回顾性研究设计，纳入2023年12月至2026年4月在南京医科大学附属逸夫医院因胃食管反流病（GERD）接受胃底折叠术联合HH修补术患者94例。所有患者术前均完成食管钡剂造影、上消化道内镜及胸腹部CT检查，以检查原始正式报告为判定依据，至少一项报告提示HH定义为术前检出，三项均未报告为术前未检出。采用Firth惩罚似然Logistic回归分析术前检出的独立相关因素，采用Cochran Q检验比较三种检查的总体配对检出率。研究仅纳入参照标准阳性的手术病例，检出率仅反映该特定手术人群中的病例检出情况，不能估计特异度、阳性预测值、阴性预测值或总体诊断准确性。

94例患者中，术前检出组31例（33.0%），术前未检出组63例（67.0%）。术前检出组患者的中位年龄高于术前未检出组[69.0（58.5，82.0）岁比59.0（55.0，71.5）岁，P=0.026]，食管裂孔缺损面积亦大于术前未检出组[15.00（6.00，16.50）cm²比6.00（4.50，11.25）cm²，P<0.001]。Ⅰ型与Ⅱ~Ⅳ型HH患者的术前检出率差异有统计学意义（P<0.001）。多因素Firth惩罚似然Logistic回归结果显示，与Ⅰ型相比，Ⅱ~Ⅳ型HH患者术前检出的优势更高（OR=8.410，95% CI 1.991~48.859；P=0.003）；食管裂孔缺损面积每增加1 cm²，术前检出的优势增加约8.4%（OR= 1.084，95% CI 1.002~1.178；P=0.045）。年龄、性别及体重指数与术前检出无独立相关性（均P>0.05）。食管钡剂造影、上消化道内镜及胸腹部CT分别检出HH 19例（20.2%）、16例（17.0%）和25例（26.6%），三种检查的总体配对检出率比较未达到统计学显著性阈值（Cochran Q=5.727，P=0.057）。

在接受抗反流手术且术中证实存在HH的患者中，HH类型和食管裂孔缺损面积与术前检出独立相关；Ⅰ型HH及裂孔缺损面积较小者术前更不易被检出。三种常规检查的总体比较未达到统计学显著阈值。

To analyze the preoperative detection of hiatal hernia (HH) and related factors in patients undergoing anti-reflux surgery, and to compare the report-based detection proportions of barium esophagography, upper gastrointestinal endoscopy, and thoracoabdominal computed tomography (CT) among patients with intraoperatively confirmed HH.

This single-center retrospective study included 94 patients who underwent fundoplication with HH repair for gastroesophageal reflux disease (GERD) at Sir Run Run Shaw Hospital Affiliated to Nanjing Medical University, between December 2023 and April 2026. All patients underwent preoperative barium esophagography, upper gastrointestinal endoscopy, and thoracoabdominal CT. Judgment was determined from the original formal clinical reports. HH reported by at least one examination was defined as the preoperative detection group, whereas no HH reported by any examination was defined as the preoperative non-detection group. Firth penalized logistic regression was used to identify factors independently associated with preoperative detection, and Cochran's Q test was used to compare the paired detection proportions of the three examinations. Because only reference-standard-positive surgical cases were included in this study, the detection proportion only reflects the case detection situation within this specific surgical population. Specificity, positive and negative predictive values, and overall diagnostic accuracy could not be estimated.

Among the 94 patients, 31 cases (33.0%) were detected before the operation, while 63 cases (67.0%) were not detected before the operation. The preoperative detection group had a higher median age than the non-detection group [69.0 (58.5, 82.0) years vs 59.0 (55.0, 71.5) years, P=0.026], and a larger hiatal defect area [15.00 (6.00, 16.50) cm² vs 6.00 (4.50, 11.25) cm², P<0.001]. Detection proportion differed significantly between type I and type Ⅱ-Ⅳ HH (P<0.001). Multivariable Firth penalized logistic regression showed higher odds of detection for type Ⅱ-Ⅳ HH than type I HH (OR=8.410, 95% CI: 1.991-48.859; P=0.003). Each 1-cm² increase in hiatal defect area was associated with an 8.4% increase in the odds of detection (OR=1.084, 95% CI: 1.002-1.178; P=0.045). Age, sex, and body mass index were not independently associated with preoperative detection (all P>0.05). Barium esophagography, upper gastrointestinal endoscopy, and thoracoabdominal CT detected HH in 19 (20.2%), 16 (17.0%), and 25 (26.6%) patients, respectively. The overall paired comparison did not reach the statistical significance threshold (Cochran's Q=5.727, P=0.057).

Among the patients who underwent anti-reflux surgery with intraoperatively confirmed HH, HH type and hiatal defect area were independently associated with preoperative detection. Type Ⅰ HH and a smaller hiatal defect area are less likely to be detected before the operation. The overall comparison of the three examinations did not reach the statistical significance threshold.