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食管裂孔疝

最后审阅: 12 Nov 2024
最后更新: 21 Dec 2022

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
完整详情

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
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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
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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)。
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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
完整详情

治疗流程

初步治疗

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

急症处理

有症状的胃食管反流病 (GORD)

持续性治疗

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
Constantine T. Frantzides

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.

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