CAJ | 학술논문

目的评价高分辨率食管测压法在食管裂孔疝诊断中的临床价值.方法经腹腔镜下Toupet法胃底折叠术治疗术前经胃镜诊断合并有食管裂孔疝的20例胃食管反流病患者,术前采用上消化道钡餐X线透视、高分辨率食管测压和24h食管pH监测检查,术中对食管裂孔情况进行观察.结果本组20例胃食管反流病患者经消化道X线钡剂造影诊断食管裂孔疝3例,高分辨率食管测压诊断食管裂孔疝9例,最终经术中确诊食管裂孔疝11例,其余9例排除食管裂孔疝.食管裂孔疝组和非食管裂孔疝组食管下括约肌长度分别为(1.92±0.38) cm和(2.10±0.92) cm(t=0.60,P ＞0.05),食管下括约肌压力(呼吸最小值)分别为(0.64±0.55) kPa和(1.31±1.07) kPa(t 1.80,P＞0.05),食管下括约肌压力(呼吸平均值)分别为(1.43±0.92) kPa和(2.57 ±1.33) kPa(t=2.26,P＜0.05).24 h食管pH监测食管裂孔疝组酸性反流指数、pH≤4的总次数和DeMeester记分均高于非食管裂孔疝组(均P ＜0.05).消化道X线钡剂造影诊断与术中确诊食管裂孔疝符合者3例,符合率27％；胃镜诊断与术中诊断符合者11例,符合率55％；高分辨率食管测压诊断与术中诊断符合者9例,符合率82％.结论食管裂孔疝的食管抗反流屏障作用减弱,反流更严重；高分辨率食管测压诊断食管裂孔疝较胃镜及消化道X线钡剂造影更为准确.
목적 평개고분변솔식관측압법재식관렬공산진단중적림상개치.방법 경복강경하Toupet법위저절첩술치료술전경위경진단합병유식관렬공산적20례위식관반류병환자,술전채용상소화도패찬X선투시、고분변솔식관측압화24h식관pH감측검사,술중대식관렬공정황진행관찰.결과 본조20례위식관반류병환자경소화도X선패제조영진단식관렬공산3례,고분변솔식관측압진단식관렬공산9례,최종경술중학진식관렬공산11례,기여9례배제식관렬공산.식관렬공산조화비식관렬공산조식관하괄약기장도분별위(1.92±0.38) cm화(2.10±0.92) cm(t=0.60,P ＞0.05),식관하괄약기압력(호흡최소치)분별위(0.64±0.55) kPa화(1.31±1.07) kPa(t 1.80,P＞0.05),식관하괄약기압력(호흡평균치)분별위(1.43±0.92) kPa화(2.57 ±1.33) kPa(t=2.26,P＜0.05).24 h식관pH감측식관렬공산조산성반류지수、pH≤4적총차수화DeMeester기분균고우비식관렬공산조(균P ＜0.05).소화도X선패제조영진단여술중학진식관렬공산부합자3례,부합솔27％；위경진단여술중진단부합자11례,부합솔55％；고분변솔식관측압진단여술중진단부합자9례,부합솔82％.결론 식관렬공산적식관항반류병장작용감약,반류경엄중；고분변솔식관측압진단식관렬공산교위경급소화도X선패제조영경위준학.
Objective To evaluate high resolution manometry in the diagnosis of hiatal hernia.Methods Clinical data were reviewed on 20 patients suffering from gastroesophageal reflux who had laparoscopic Toupet fundoplication for preoperative tentative diagnosis of hiatal hernia.Preoperative diagnosis of hiatal hernia was made collectively by endoscopy,X-ray examination,24 hour esophageal pH monitoring and high resolution manometry before surgery.Results Preoperative diagnosis of hiatal hernia was made in 3 patients by X-ray examination,in 9 patients by high resolution manometry.11 patients were finally diagnosed with hiatat hernia intraoperatively.X ray was consistent with intraoperative diagnosis in 27％ cases.Intraoperative and endoscopic diagnoses were 55％.High resolution manometry and intraoperative diagnoses were consistent in 82％.Lower esophageal sphincter length was (1.92 ± 0.38) cm in hiatal hernia group and (2.10 ± 0.92) cm in non-hiatal hernia group (t =0.60,P ＞ 0.05),lower esophageal sphincter pressure (respiratory min) was (0.64 ±0.55) kPa in hiatal hernia group and (1.31 ± 1.07) kPa in nonhiatal hernia group(t =1.80,P ＞ 0.05),and lower esophageal sphincter pressure (respiratory mean) was (1.43 ±0.92) kPa in hiatal hernia group and (2.57 ± 1.33) kPa in non-hiatal hernia group(t =2.26,P ＜0.05).The reflux parameters,including the percent total time pH ＜ 4,and DeMeester score,were significantly greater in hiatal hernia group than in non-hiatal hernia group (all P ＜ 0.05).Conclusions Hiatal hernia patients are with poor esophageal antireflux competency and severe reflux.High resolution manometry is more valuable in the diagnosis of hiatal hernia than endoscopy or X-ray examination.