伴有严重脊柱畸形食管裂孔疝患者治疗二例
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摘要
脊柱畸形,包括严重的驼背和脊柱侧弯,与食管裂孔疝多发生在老年人。有文献报道,脊柱畸形是食管裂孔疝的诱因之一。严重的脊柱畸形会导致肺功能下降,腹腔容积减少,腹壁顺应性降低,从而使食管裂孔疝修补困难,手术并发症增加。本文报道2例严重脊柱畸形,长期进食困难,靠静脉营养和鼻肠管营养的食管裂孔疝患者的救治过程。对于食管裂孔疝伴有严重脊柱畸形的患者,需要完善的术前检查和相关准备,可以获得好的疗效。
Spinal abnormalities and hiatal hernias are becoming more common in our aging population. Increasing evidence has shown that the presence of kyphoscoliosis would increase hiatal hernia formation. Kyphoscoliosis has been shown to lead to decreased quality of life, poor pulmonary function, and restrict abdominal compliance. All of these factors have the potential to increase morbidity and mortality associated with the surgical repair of hiatal abnormalities. In the present we reported two cases of hiatal hernias repair in kyphoscoliosis patients, with a prolonged duration of malnutrition due to inability to eat, and received nasogastric tube feeding or total parenteral nutrition(TPN). Operative planning and subsequent hiatal hernia repair must be undertaken in the context of these spinal abnormalities.
Spinal abnormalities and hiatal hernias are becoming more common in our aging population. Increasing evidence has shown that the presence of kyphoscoliosis would increase hiatal hernia formation. Kyphoscoliosis has been shown to lead to decreased quality of life, poor pulmonary function, and restrict abdominal compliance. All of these factors have the potential to increase morbidity and mortality associated with the surgical repair of hiatal abnormalities. In the present we reported two cases of hiatal hernias repair in kyphoscoliosis patients, with a prolonged duration of malnutrition due to inability to eat, and received nasogastric tube feeding or total parenteral nutrition(TPN). Operative planning and subsequent hiatal hernia repair must be undertaken in the context of these spinal abnormalities.
引文
1 Lonstein JE.Scoliosis:Surgical versus non-surgical treatment[J].Clin Ortho Rel Res,2006,443:248-259.
2 Kado DM,Huang MH,Karlamangla AS,et al.Hyperkyphotic posture predicts mortality in older community-dwelling men and women:a prospective study[J].J Am Geriatr Soc,2004,52(10):1662-1667.
3 Kado DM,Prenovost K,Crandall C.Narrative review:hyperkyphosis in older persons[J].Ann Intern Med,2007,147(5):330-338.
4 Polomsky M,Peters JH,Schwartz SI.Hiatal hernia and disorders of the spine:a historical perspective[J].Dis Esophagus,2012,25(5):367-372.
5 Polomsky M,Siddall KA,Salvador R,et al.Association of kyphosis and spinal skeletal abnormalities with intrathoracic stomach:a link toward understanding its pathogenesis[J].J Am Coll Surg,2009,208(4):562-569.
6 Comte H.Esophageal hiatal hernia in the kyphoscoliotic aged[J].Maroc Med,1953,32(340):872-874.
7 Kassem NY,Groen JJ,Fraenkel M.Spinal deformities and oesophageal hiatus hernia[J].Lancet,1965,1(7391):887-889.
8 Hoeffel JC,Lascombes P,Schmitt M,et al.Peptic esophagitis and scoliosis in children[J].Ann de Ped,1992,39(9):561-565.
9 Kahl E,Koch E.Hiatal hernia in kyphosis and scoliosis.Gastroenterologia,1966,106(3):165-170.
10 Rudowski W,Kolakowski L,Klawe Z,et al.Studies on the coincidence of esophageal hiatal hernia and scoliosis[J].Pol Arch Med Wewn,1968,41(2):259-264.
11 Kostuik JP,Bentivoglio J.The incidence of low-back pain in adult scoliosis[J].Spine,1981,6(3):268-273.
12 Carter OD,Haynes S.Prevalence rates for scoliosis in US adults:Results from the first National Health and Nutrition Examination Survey[J].Int J Epidemiol,1987,16(4):537-544.
13 Schuchert MJ,Adusumilli PS,Cook CC,et al.The impact of scoliosis among patients with giant paraesophageal hernia[J].J Gastrointest Surg,2011,15(1):23-28.
14 Kusano M,Hashizume K,Ehara Y,et al.Size of hiatus hernia correlates with severity of kyphosis,not with obesity,in elderly Japanese women[J].Clin Gastroenterol,2008,42(4):345-350.
15 Senyk J,Arborelius M,Lilja B,et al.Respiratory function in esophageal hiatus hernia.Ⅰ.Spirometry,gas distribution,and arterial blood gases[J].Respiration,1975,32(2):93-102.
16 Low DE,Simchuk EJ.Effect of paraesophageal hernia repair on pulmonary function[J].Ann Thorac Surg,2002,74(2):333-337.
2 Kado DM,Huang MH,Karlamangla AS,et al.Hyperkyphotic posture predicts mortality in older community-dwelling men and women:a prospective study[J].J Am Geriatr Soc,2004,52(10):1662-1667.
3 Kado DM,Prenovost K,Crandall C.Narrative review:hyperkyphosis in older persons[J].Ann Intern Med,2007,147(5):330-338.
4 Polomsky M,Peters JH,Schwartz SI.Hiatal hernia and disorders of the spine:a historical perspective[J].Dis Esophagus,2012,25(5):367-372.
5 Polomsky M,Siddall KA,Salvador R,et al.Association of kyphosis and spinal skeletal abnormalities with intrathoracic stomach:a link toward understanding its pathogenesis[J].J Am Coll Surg,2009,208(4):562-569.
6 Comte H.Esophageal hiatal hernia in the kyphoscoliotic aged[J].Maroc Med,1953,32(340):872-874.
7 Kassem NY,Groen JJ,Fraenkel M.Spinal deformities and oesophageal hiatus hernia[J].Lancet,1965,1(7391):887-889.
8 Hoeffel JC,Lascombes P,Schmitt M,et al.Peptic esophagitis and scoliosis in children[J].Ann de Ped,1992,39(9):561-565.
9 Kahl E,Koch E.Hiatal hernia in kyphosis and scoliosis.Gastroenterologia,1966,106(3):165-170.
10 Rudowski W,Kolakowski L,Klawe Z,et al.Studies on the coincidence of esophageal hiatal hernia and scoliosis[J].Pol Arch Med Wewn,1968,41(2):259-264.
11 Kostuik JP,Bentivoglio J.The incidence of low-back pain in adult scoliosis[J].Spine,1981,6(3):268-273.
12 Carter OD,Haynes S.Prevalence rates for scoliosis in US adults:Results from the first National Health and Nutrition Examination Survey[J].Int J Epidemiol,1987,16(4):537-544.
13 Schuchert MJ,Adusumilli PS,Cook CC,et al.The impact of scoliosis among patients with giant paraesophageal hernia[J].J Gastrointest Surg,2011,15(1):23-28.
14 Kusano M,Hashizume K,Ehara Y,et al.Size of hiatus hernia correlates with severity of kyphosis,not with obesity,in elderly Japanese women[J].Clin Gastroenterol,2008,42(4):345-350.
15 Senyk J,Arborelius M,Lilja B,et al.Respiratory function in esophageal hiatus hernia.Ⅰ.Spirometry,gas distribution,and arterial blood gases[J].Respiration,1975,32(2):93-102.
16 Low DE,Simchuk EJ.Effect of paraesophageal hernia repair on pulmonary function[J].Ann Thorac Surg,2002,74(2):333-337.