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中华胃食管反流病电子杂志 ›› 2022, Vol. 09 ›› Issue (04) : 174 -180. doi: 10.3877/cma.j.issn.2095-8765.2022.04.001

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成人胃食管反流病外科诊疗共识(2022版)
中国医师协会外科医师分会胃食管反流病专业委员, 汪忠镐, 克力木·阿不都热依木, 仇明, 嵇振岭, 吴继敏, 姚琪远, 伍冀湘, 杨福全, 陈建德, 艾克拜尔·艾力, 张伟, 李俊生, 胡志伟, 花荣, 黄迪宇, 季锋, 王知非, 熊茂明, 路夷平, 王秋生, 吴立胜, 周太成, 杨春, 黄允宁, 刘殿刚, 石玉龙, 谭敏, 张辉, 赵宏志, 赵文星, 樊勇, 王黔, 王举, 孙做成, 康建省, 王志, 阿力木江·麦斯依提   
  • 收稿日期:2022-10-12 出版日期:2022-11-15
  • Received:2022-10-12 Published:2022-11-15
引用本文:

中国医师协会外科医师分会胃食管反流病专业委员, 汪忠镐, 克力木·阿不都热依木, 仇明, 嵇振岭, 吴继敏, 姚琪远, 伍冀湘, 杨福全, 陈建德, 艾克拜尔·艾力, 张伟, 李俊生, 胡志伟, 花荣, 黄迪宇, 季锋, 王知非, 熊茂明, 路夷平, 王秋生, 吴立胜, 周太成, 杨春, 黄允宁, 刘殿刚, 石玉龙, 谭敏, 张辉, 赵宏志, 赵文星, 樊勇, 王黔, 王举, 孙做成, 康建省, 王志, 阿力木江·麦斯依提. 成人胃食管反流病外科诊疗共识(2022版)[J]. 中华胃食管反流病电子杂志, 2022, 09(04): 174-180.

图1 容积测定。图A 示胃腔及局部腹腔内脂肪经食管裂孔向上疝入纵隔后方;图B 示测量疝环口直径约60.3 mm;图C示测量侧位疝囊最大径和最小径;图D示测量正位疝囊最大径和最小径。通过计算得出:疝囊大小约134 mm×186 mm,疝囊容积约1476.4 cm3
图2 不同胃底折叠术联合Sleeve 术 图A为Sleeve+360°折叠;图B为Sleeve+270°折叠;图C为Sleeve+180°折叠
图3 根据食管测压和24 h食管pH监测选择抗反流术式的参考流程 注:GERD 为胃食管反流病,LES 为食管下括约肌
图4 目前常用的3种不同抗反流术式。图A为360°折叠;图B为270°折叠;图C为180°折叠
图5 A 完全游离后的食管裂孔结构。B 间断缝合关闭食管裂孔。C 连续缝合关闭食管裂孔。D 关闭后错位张力线,以增强关闭张力又能减少膈肌脚撕裂。
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