小结
定义
病史和体格检查
关键诊断因素
- 存在的危险因素
- 胸部出现肠鸣音
其他诊断因素
- 烧心
- 反流
- 肥胖
- 胸痛
- 吞咽困难
- 吞咽痛
- 呕血
- 呼吸短促
- 咳嗽
- 咽炎
- 哮鸣音
- 不含胆汁的呕吐
- 发热和寒战
- 意识模糊
危险因素
- 肥胖
- 年龄增长
- 既往的胃-食管手术
- 腹内压升高
- 男性
- 食管裂孔或膈食管韧带的结构异常。
- 切口疝，脐疝或腹股沟疝
- 胶原代谢紊乱
诊断性检查
首要检查
- 胸部 X 线检查
- 上消化道造影检查（食道钡餐造影）。
需考虑的检查
- 食管胃十二指肠镜检查
- CT扫描或磁共振成像(MRI)
- 高分辨率食管测压和 pH 监测
治疗流程
上消化道出血和/或梗阻和/或胃扭转
不可逆的器官缺血和（或）坏死
有症状的胃食管反流病 (GORD)
I型食管裂孔疝药物治疗无效或患者倾向于手术治疗
II，III和IV型
撰稿人
作者
Constantine T. Frantzides, MD, PhD, FACS
Director
Chicago Institute of Minimally Invasive Surgery
St. Francis Hospital
Clinical Professor of Surgery
University of Illinois Chicago
Chicago
IL
利益声明
CTF declares that he has no competing interests.
Amy J. Hargrove, MD, MPH
General Surgery Resident
University of Nebraska Medical Center
Omaha
NE
利益声明
AJH declares that she has no competing interests.
Mark A. Carlson, MD, FACS
Director
Center for Advanced Surgical Technology
Professor
Department of Surgery
University of Nebraska Medical Center
Omaha
NE
利益声明
MAC declares that he has no competing interests.
鸣谢
Dr Constantine T. Frantzides, Dr Amy Hargrove, and Dr Mark A. Carlson would like to gratefully acknowledge Dr Minh B. Luu, a previous contributor to this topic. MBL declares that he has no competing interests.
同行评议者
Frank A. Granderath, MD
Associate Professor
Department of General, Visceral and Transplant Surgery
University Hospital Tuebingen
Germany
利益声明
FAG declares that he has no competing interests.
鉴别诊断
- 心绞痛
- 胃食管反流病 (GORD)
- 肺炎
更多 鉴别诊断指南
- 消化道内镜操作的知情同意
- 非静脉曲张性上消化道出血共识：2018 年更新版
更多 指南
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