食管裂孔疝有关抗反流手术术前检查专家共识（2026版）

Expert consensus on preoperative evaluation for antireflux surgery in hiatal hernia (2026 edition)

摘要:

食管裂孔疝（HH）是胃食管反流病（GERD）的重要病因之一。目前，HH相关抗反流手术的术前检查策略尚缺乏统一规范，不同检查方式的适应证、组合模式及结果解读仍存在争议，影响手术决策及疗效评估。为规范我国HH相关抗反流手术的术前评估流程，中国医师协会外科医师分会胃食管反流疾病诊疗外科专家工作组联合多家学术组织，组织国内104位专家，通过线下讨论与线上德尔菲投票，结合国内外最新指南、共识及循证医学证据，围绕24 h食管pH监测、高分辨率食管测压、胃镜、上消化道造影、胸腹部CT、胃食管充盈超声造影及其他辅助检查等七个核心问题形成推荐意见。本共识强调建立以“症状-功能-解剖”为核心的多维度术前评估体系，提出分层化、个体化的检查策略，并强调多学科协作在复杂病例管理中的重要作用，以期为HH相关抗反流手术术前检查的规范化开展提供参考。鉴于当前相关研究证据总体有限，未来仍需更多高质量研究进一步优化术前评估体系。

Abstract:

Hiatal hernia (HH) is an important etiological factor of gastroesophageal reflux disease (GERD). However, the preoperative evaluation strategies for HH-related antireflux surgery remain insufficiently standardized, and controversies still exist regarding the indications, combinations, and interpretation of different diagnostic modalities, which may affect surgical decision-making and postoperative outcomes. To standardize the preoperative assessment of HH-related antireflux surgery in China, the Expert Working Group on Gastroesophageal Reflux Disease of the Chinese Medical Doctor Association, together with multiple academic societies, convened 104 experts nationwide to develop consensus recommendations through face-to-face discussions and Delphi voting. Based on the latest international and domestic guidelines, consensus statements, and current evidence, recommendations were established for seven core aspects of preoperative evaluation, including 24-hour esophageal pH monitoring, high-resolution esophageal manometry, endoscopy, upper gastrointestinal contrast studies, chest and abdominal computed tomography, gastroesophageal contrast-enhanced ultrasonography, and other adjunctive examinations. This consensus emphasizes a multidimensional preoperative assessment system centered on symptoms, function, and anatomy, advocates individualized and stratified diagnostic strategies, and highlights the importance of multidisciplinary collaboration in the management of complex cases. The aim of this consensus is to provide practical guidance for the standardized preoperative evaluation of HH-related antireflux surgery. Given the overall limited quality of current evidence, more high-quality research is still needed in the future to further optimize the preoperative assessment system.