对于症状明显、药物治疗无效或存在并发症的食管裂孔疝病人，手术是主要治疗手段。术中尤其须重视对迷走神经前、后干，左、右膈下动脉，胃左动脉分支及食管周围微小血管网的精细解剖与保护，以避免术后吞咽功能障碍、胃排空延迟或出血等并发症。在每个手术环节中应贯彻精细化解离、直视下操作、避免盲目电灼和过深缝合的原则。基于精细解剖学理念的术中操作，不仅有助于提高疝修补的解剖复位质量，更能显著提升病人术后生活质量与长期疗效。

For patients with hiatal hernia who present with significant symptoms, show poor response to medication, or have complications, surgery is the primary treatment. During the procedure, particular attention must be paid to the meticulous dissection and preservation of the anterior and posterior vagal trunks, the left and right inferior phrenic arteries, the branches of the left gastric artery, and the periesophageal vascular network, in order to avoid postoperative complications such as swallowing dysfunction, delayed gastric emptying, or bleeding. In each surgical step, the principles of meticulous dissection, direct visualization, avoidance of blind electrocoagulation, and excessively deep suturing should be adhered to. Intraoperative techniques guided by the concept of precise anatomy not only improve the quality of anatomical reduction in hernia repair but also significantly enhance patients' postoperative quality of life and long-term outcomes.