中国实用外科杂志

中国实用外科杂志

• 专题笔谈 • 上一篇    下一篇

食管裂孔疝复发再手术治疗策略

黄恩民，侯泽辉，马    宁，陈    双，周太成   

  1. 中山大学附属第六医院疝和腹壁外科，广东广州 510655
  • 出版日期:2025-05-01

  • Online:2025-05-01

摘要： 食管裂孔疝术后复发率较高，其再手术治疗需综合解剖、技术及病人特征进行个体化决策。食管裂孔疝的复发机制涉及胶原代谢异常、缝合张力过高及补片选择争议，而肥胖、高龄及Barrett食管等因素进一步增加复杂性。再手术适应证包括症状顽固（胃食管反流病健康相关生活质量问卷评分≥20分）、疝囊体积增大（>500 cm³）或急性并发症（如胃扭转）。技术策略上，生物补片（如P4HB）联合机器人辅助手术可降低复发率至4.8%，而Keyhole形补片设计较传统U形补片复发风险降低50%。术后需结合影像学检查结果（每年行CT）及生活方式干预（控制体重、戒烟），以降低二次复发风险。未来发展方向可聚焦智能补片、基因靶向及人工智能手术规划，但仍需多中心研究验证长期疗效。

关键词: 食管裂孔疝, 复发疝, 再手术, 生物补片, 机器人辅助手术, 个体化治疗

Abstract: Recurrent hiatal hernia (HH) after initial repair remains a high recurrence rates and its reoperation requires personalized strategies integrating anatomical, technical, and patient-specific factors. Key recurrence mechanisms include collagen metabolism dysfunction, excessive suture tension, and suboptimal mesh selection, compounded by obesity, advanced age, and Barrett's esophagus. Indications for reoperation include refractory symptoms (GERD-HRQL score ≥20), large hernia volume (>500 cm³), or acute complications (e.g., gastric volvulus). Technical advancements such as biosynthetic mesh (e.g., P4HB) and robotic-assisted surgery reduce recurrence rates to 4.8%, while keyhole-shaped mesh lowers recurrence risk by 50% compared to U-shaped configurations. Postoperative management emphasizes imaging surveillance (annual CT) and lifestyle modifications (weight control, smoking cessation), cutting secondary recurrence. Future innovations include smart meshes, genetic biomarkers, and AI-driven surgical planning, though multicenter trials are needed to validate long-term outcomes.

Key words: hiatal hernia, recurrent hernia, reoperation, biosynthetic mesh, robotic-assisted surgery, personalized therapy