摘要目的:总结和探讨先天性食管闭锁术后合并食管裂孔疝患儿的诊疗经验和体会。方法:回顾性分析2013年1月至2019年6月收治的食管闭锁术后确诊食管裂孔疝患儿22例的临床资料。其中，男17例，女5例；出生体重为(2 438.0±381.2)g，范围在1 750～3 060 g；出生孕周为(37.5±2.1)周，范围在33～40 ＋6周。22例患儿中原发食管闭锁Ⅰ型7例，Ⅲ型15例，均通过上消化道造影检查确诊食管裂孔疝。其中4例患儿临床症状不显著，于我科定期随访；18例行手术治疗。 结果:18例手术患儿中15例成功施行腹腔镜手术，3例因胃与肝粘连严重行开放手术；采用Nissen术式10例，Toupet术式8例。18例患儿至今随访1～47个月，中位随访时间为12个月。复查上消化道造影发现食管裂孔疝复发4例。其中，2例行24 h pH监测提示夜间病理性反流，再次行Nissen手术修补；2例无病理性反流症状，暂未再次手术治疗。18例手术患儿术后反流症状均较前明显好转，5例夜间偶有反流，质子泵抑制剂治疗中。14例生长发育良好，与正常同龄儿无明显差异，4例患儿身高体重暂处于同龄儿2个标准差以下。结论:食管闭锁患儿应重视合并食管裂孔疝的可能；定期复查上消化道造影有助于早期诊断合并食管裂孔疝，尤其是Ⅰ型食管闭锁术后获得性食管裂孔疝的发生；腹腔镜Nissen手术可作为首选治疗方案。

abstractsObjective:Hiatal hernia is rarely reported in children with congenital esophageal atresia. We analyzed the clinical data of 22 children with esophageal atresia plus hiatal hernia and summarized our diagnostic and therapeutic experiences.Methods:From January 2013 to June 2019, 22 children with hiatal hernia after reconstructions for esophageal atresia were admitted. There were 17 boys and 5 girls with a birth weight of (2438.0±381.2)(1750-3060) gram and a gestational age of (37.5±2.1)(33-40 + 6) weeks. The clinical types of esophageal atresia were I (n=7) and Ⅲ (n=15). The diagnosis of hiatal hernia was confirmed by upper gastrointestinal radiography. Among them, 4 cases without obvious clinical symptoms are followed up regularly and 18 children underwent anti-reflux surgery. Results:Laparoscopy was successfully performed in 15 cases. And open surgery was performed in 3 cases due to extensive gastrohepatic adhesion. The specific procedures were Nissen (n=10) and Toupet (n=8). During a median follow-up period of 12(1-47) months, 4 recurrent cases of hiatal hernia were detected by upper gastrointestinal radiography. According to 24-hour pH monitoring, two children of nocturnal pathological reflux underwent Nissen procedure again while another two without pathological reflux were observed conservatively. Clinical reflux-related symptoms improved markedly after anti-reflux surgery. Five children with occasional nocturnal reflux received proton-pump inhibitor (PPI). The growth of 14 children was normal and there was no significant difference from normal counterparts of the same age. The height and weight of 4 children were 2 standard deviations below than those of the same age temporarily.Conclusions:The possibility of hiatal hernia should be considered in children with esophageal atresia. Regular upper gastrointestinal radiography contributes to its early diagnosis and treatment after esophageal reconstruction, especially for acquired hiatus hernia in children with type I esophageal atresia. Nissen's laparoscopy may be a preferred treatment.