测量健康成人的食管裂孔面积（HSA）与食管横截面积（ESA），建立HSA正常参考值并计算ESA/HSA比值，为食管裂孔疝（HH）的诊断提供形态学依据。

回顾性分析2022年11月至2024年12月于浙江大学医学院附属邵逸夫医院接受24 h食管pH阻抗监测的受试者资料。在监测前后6个月内受试者需完成高分辨率食管测压（HRM）、上消化道内镜及上腹部/胸部增强CT检查。排除存在典型反流症状、反流参数异常（酸暴露时间>4%或DeMeester评分>14.72分）、内镜或影像学确诊HH、HRM异常、既往存在膈肌或HH手术史、病历资料不全者。通过多层螺旋CT图像进行多平面重建，测量受试者HSA与ESA，并计算ESA/HSA比值。采用独立样本t检验比较不同性别上述指标的差异，采用Pearson相关分析年龄与HSA、ESA的相关性。以P<0.01为差异有统计学意义。

最终纳入39例受试者，其中男性13例（33.3%）、女性26例（66.7%），年龄为（52±14）岁。HSA为（228.4±52.9）mm²，ESA为（140.8±42.1）mm²，ESA/HSA比值为0.61±0.10。性别比较显示，男性与女性HSA分别为（245.6±48.3）mm²与（222.5±54.1）mm²，ESA分别为（145.2±39.8）mm²与（135.4±43.5）mm²，差异均无统计学意义（P均>0.01）。年龄与HSA（r=0.306，P=0.059）、ESA（r=0.348，P=0.030）均无相关性。

本研究首次报道了健康成人HSA与ESA的正常参考值及ESA/HSA比值，该比值有望作为评估食管裂孔功能状态的新型形态学指标，为HH的精准诊断提供参考依据。

To measure the esophageal hiatus area (HSA) and esophageal cross-sectional area (ESA) in healthy adults, establish the normal reference value for HSA, and calculate the ESA/HSA ratio, thereby providing morphological evidence for the diagnosis of hiatal hernia (HH).

This retrospective study analyzed medical records of patients who underwent 24-hour esophageal pH-impedance monitoring at Sir Run Run Shaw Hospital, Zhejiang University School of Medicine from November 2022 to December 2024. Eligible patients completed high-resolution manometry (HRM), upper gastrointestinal endoscopy, and enhanced CT scans of the upper abdomen/chest within six months of monitoring. Exclusion criteria included the presence of typical reflux symptoms, abnormal reflux parameters (acid exposure time >4% or DeMeester score >14.72), diagnosis of HH by endoscopy or imaging, abnormal HRM findings, previous diaphragmatic or HH surgery, and incomplete medical records. HSA and ESA were measured using multidetector computed tomography (MDCT) with multiplanar reconstruction technique, and the ESA/HSA ratio was calculated. An independent samples t-test was used to compare sex differences, and Pearson correlation analysis was used to assess the correlation between age and HSA/ESA. A two-tailed P<0.01 was considered statistically significant.

A total of 39 subjects were included, comprising 13 males (33.3%) and 26 females (66.7%), with a mean age of (52±14) years. HSA was (228.4±52.9) mm², ESA was (140.8±42.1) mm², and the ESA/HSA ratio was 0.61±0.10. No significant sex differences were observed in HSA [males (245.6±48.3)mm² vs females (222.5±54.1)mm²] or ESA [males (145.2±39.8) mm² vs females (135.4±43.5)mm²]. Age was not significantly correlated with HSA (r=0.306, P=0.059) or ESA (r=0.348, P=0.030).

This study reports for the first time the normal reference values for HSA and ESA and the ESA/HSA ratio in healthy adults. The ESA/HSA ratio demonstrates good stability and may serve as a novel morphological indicator for assessing the functional status of the esophageal hiatus, providing a reference for the accurate diagnosis of HH.