中国实用外科杂志2025，Vol.45Issue(5)：509-513,5.DOI:10.19538/j.cjps.issn1005-2208.2025.05.06
食管裂孔疝复发再手术治疗策略
Surgical strategies for recurrent hiatal hernia
摘要
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.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Key words
hiatal hernia/recurrent hernia/reoperation/bio-synthetic mesh/robotic-assisted surgery/personalized therapy分类
临床医学引用本文复制引用
黄恩民,侯泽辉,马宁,陈双,周太成..食管裂孔疝复发再手术治疗策略[J].中国实用外科杂志,2025,45(5):509-513,5.基金项目
Guangzhou Municipal Science and Technology Program(No.202201010808) 广州市科技计划项目(No.202201010808) （No.202201010808）
