CAJ | 학술논문

目的探讨贲门失弛缓症患者改良Heller术后远期食管运动功能变化的特点.方法 1998年至2004年,首都医科大学附属北京同仁医院胸外科随访经腹改良Heller术治疗贲门失弛缓症患者72例,随访期3～10年.对其症状、食管动力学和食管腔内24 h的pH值等进行记录.结果食管下括约肌切开侧压力由术前(44±12)mm Hg降至(10±5)mm Hg,松弛率由49%±20%升至84%±15%,差异有统计学意义(P<0.05).有进食梗阻感的24例患者中,11例食管下括约肌两个方向压力高于正常,松弛功能不良;7例3个方向压力高于正常,松弛功能不良.全组患者吞咽后体部全部表现为同步收缩及无传导收缩,缺乏推进性蠕动.结论成功的改良Heller术后远期食管动力学功能特点为:①食管下括约肌的静息压力至少一个方向压力低于正常,至少一个方向压力高于正常.②食管下括约肌在吞咽时食管后壁仍弛缓障碍,不能充分松弛.术后进食有梗阻感者,表现为2～3个方向松弛不良.③吞咽时食管体均为同步收缩波,无正常的蠕动波可见,食物靠重力作用通过食管.
목적 탐토분문실이완증환자개량Heller술후원기식관운동공능변화적특점.방법 1998년지2004년,수도의과대학부속북경동인의원흉외과수방경복개량Heller술치료분문실이완증환자72례,수방기3～10년.대기증상、식관동역학화식관강내24 h적pH치등진행기록.결과 식관하괄약기절개측압력유술전(44±12)mm Hg강지(10±5)mm Hg,송이솔유49%±20%승지84%±15%,차이유통계학의의(P<0.05).유진식경조감적24례환자중,11례식관하괄약기량개방향압력고우정상,송이공능불량;7례3개방향압력고우정상,송이공능불량.전조환자탄인후체부전부표현위동보수축급무전도수축,결핍추진성연동.결론 성공적개량Heller술후원기식관동역학공능특점위:①식관하괄약기적정식압력지소일개방향압력저우정상,지소일개방향압력고우정상.②식관하괄약기재탄인시식관후벽잉이완장애,불능충분송이.술후진식유경조감자,표현위2～3개방향송이불량.③탄인시식관체균위동보수축파,무정상적연동파가견,식물고중력작용통과식관.
Objective To investigate the long-term characteristics of both clinical manifestation and esophageal motor disturbance in achalasia patients after Heller's myotmy. Methods After 3 to 10 years' follow-up, clinical manifestation, esophageal motor function and 24-hour continuous esophageal pH monitoring in 72 post-operative cases of achalasia were recorded. Results The mean LES pressure decreased from 44 ± 12 mm Hg to 10 ±5 mm Hg , and the rate of L ES relaxation rised from 49% ±20% to 84% ±15% (paired t test, P<0.05). Of 24 cases with choking feeling, 11 had the high LES pressure and dysfunction in two directions and 7 in three. During swallowing, incomplete lower esophageal sphincter relaxation and aperistalsis were detected in all patients. Conclusions The long-term characteristics of esophageal function following successfully surgical treatment to patients with Achalasia are: