Data_Sheet_2_Impact of Paraesophageal Hernia Repair on Respiratory Function: A Systematic Review.docx

Background and Objectives: Surgical repair of hiatal and paraesophageal hernia is widely accepted for the treatment of gastroesophageal reflux symptoms. The respiratory benefit of this surgery is less clear. The objective of this review is to quantify the benefit to pulmonary function and subjective dyspnea of paraesophageal hernia repair with the aim of refining the indications and contraindications for elective paraesophageal hernia repair.
Methods: Articles were gathered from systematic searches of the Medline Complete Database via the Creighton University Health Sciences Library literature search services. Publications with both pre and postoperative pulmonary function data or both pre and postoperative subjective dyspnea data with regards to surgical paraesophageal hernia repair were included.
Results: Six studies were included in this review. The majority of studies in this review show improvement in pulmonary function postoperatively with regards to FEV1, FVC, and VC when stratified by % intrathoracic stomach (ITS), particularly in groups >50% ITS. No significant change was seen in postoperative DLCO or FEV1/FVC.
Conclusion: Paraesophageal hernia repair has shown to improve pulmonary function both objectively and subjectively. This review was limited by the paucity of literature on the subject as well as the lack of a standardized method for measurement of %ITS.

背景与目的：食管裂孔疝与食管旁疝的手术修补已被广泛认可用于治疗胃食管反流症状，但该手术的呼吸获益仍尚不明确。本综述旨在量化食管旁疝修补术对肺功能及主观呼吸困难的改善效果，以期优化择期食管旁疝修补术的适应证与禁忌证。
研究方法：本研究通过克莱顿大学健康科学图书馆文献检索服务，对完整医学文献数据库Medline（Medline Complete Database）开展系统性检索以收集相关文献。纳入标准为：同时包含食管旁疝手术修补术前与术后肺功能数据，或同时包含术前与术后主观呼吸困难评估数据的已发表研究。
研究结果：本综述共纳入六项研究。本综述中多数研究显示，按胸腔内胃占比（% intrathoracic stomach, ITS）分层后，术后患者的第一秒用力呼气容积（Forced Expiratory Volume in 1 Second, FEV1）、用力肺活量（Forced Vital Capacity, FVC）及肺活量（Vital Capacity, VC）均得到改善，尤其是胸腔内胃占比＞50%的亚组。术后一氧化碳弥散量（Diffusing Capacity of the Lung for Carbon Monoxide, DLCO）及FEV1/FVC比值未出现显著变化。
研究结论：食管旁疝修补术已被证实可在客观与主观层面改善肺功能。本综述的局限性在于该主题相关文献数量匮乏，且缺乏胸腔内胃占比的标准化测量方法。