中华消化杂志
中華消化雜誌
중화소화잡지
Chinese Journal of Digestion
2013年
6期
375-379
,共5页
汪之沫%余晓云%蔺蓉%熊汉华%谢小平%侯晓华
汪之沫%餘曉雲%藺蓉%熊漢華%謝小平%侯曉華
왕지말%여효운%린용%웅한화%사소평%후효화
食管括约肌,下段%膈%疝,食管裂孔%胃镜检查
食管括約肌,下段%膈%疝,食管裂孔%胃鏡檢查
식관괄약기,하단%격%산,식관렬공%위경검사
Esophageal sphincter,lower%Diaphragm%Hernia,hiatal%Gastroscopy
目的 分析下食管括约肌(LES)与膈肌分离患者的胃镜表现,探究其在诊断食管裂孔疝(HH)中的意义.方法 回顾性分析2011年1月至2012年6月的高分辨率食管测压(HRM)患者资料,从中筛选提示LES与膈肌分离的患者,排除上消化道手术史及缺乏完整胃镜资料的病例,共93例纳入分析.按芝加哥标准分成3组,Ⅰ型组(LES与膈肌分离＜1 cm)21例；Ⅱ型组(LES与膈肌分离1～＜2 cm)37例；Ⅲ型组(LES与膈肌分离≥2 cm) 35例.分析各组间胃镜表现差异.以HRM为金标准,计算胃镜诊断HH的敏感度、特异度.计量资料以(-x)±s表示,多组间均数比较采用单因素方差分析,两两比较采用LSD法或Dunnett T3检验.两组间率的比较采用卡方检验或Fisher确切概率法.结果 3组间胃食管连接部(EGJ)与门齿的距离差异无统计学意义(P＞0.05),而EGJ与膈食管裂孔压迹的距离:Ⅲ型组[(3.57±0.78) cm]＞Ⅱ型组[(1.89±0.81) cm]＞Ⅰ型组[(1.14±0.67) cm],差异均有统计学意义LSD-t=9.26、11.44、3.57,P均＜0.05].贲门久开和胃囊上压迹出现率:Ⅲ型组＞Ⅱ型组＞Ⅰ型组(80.0％、40.5％、4.8％,x2=11.64、29.76、8.59,P均＜0.05；91.4％、27.1％、4.8％,x2=30.69、40.73、4.32,P均＜0.05).His角变钝(可从食管看到胃体)和疝囊出现率:Ⅲ型组大于Ⅰ型组和Ⅱ型组(分别为74.3％和77.1％,24.3％和24.3％,4.8％和4.8％;x2=17.97、25.41,P均＜0.05),Ⅰ型组和Ⅱ型组差异均无统计学意义(P均＞0.05).食管炎发生率:Ⅲ型组和Ⅱ型组皆大于Ⅰ型组(71.4％,59.5％,14.3％；x2=17.14、11.15,P均＜0.05),Ⅲ型组和Ⅱ型组差异无统计学意义(P＞0.05).Barrett食管在:3组各1例.胃镜诊断HH敏感度为91.4％,特异度为81.0％.结论 HH的胃镜表现中,EGJ与膈食管裂孔压迹距离、贲门久开、His角变钝、胃囊上压迹及疝囊是比较重要的指标.胃镜诊断HH敏感度较高,特异度偏低.
目的 分析下食管括約肌(LES)與膈肌分離患者的胃鏡錶現,探究其在診斷食管裂孔疝(HH)中的意義.方法 迴顧性分析2011年1月至2012年6月的高分辨率食管測壓(HRM)患者資料,從中篩選提示LES與膈肌分離的患者,排除上消化道手術史及缺乏完整胃鏡資料的病例,共93例納入分析.按芝加哥標準分成3組,Ⅰ型組(LES與膈肌分離＜1 cm)21例；Ⅱ型組(LES與膈肌分離1～＜2 cm)37例；Ⅲ型組(LES與膈肌分離≥2 cm) 35例.分析各組間胃鏡錶現差異.以HRM為金標準,計算胃鏡診斷HH的敏感度、特異度.計量資料以(-x)±s錶示,多組間均數比較採用單因素方差分析,兩兩比較採用LSD法或Dunnett T3檢驗.兩組間率的比較採用卡方檢驗或Fisher確切概率法.結果 3組間胃食管連接部(EGJ)與門齒的距離差異無統計學意義(P＞0.05),而EGJ與膈食管裂孔壓跡的距離:Ⅲ型組[(3.57±0.78) cm]＞Ⅱ型組[(1.89±0.81) cm]＞Ⅰ型組[(1.14±0.67) cm],差異均有統計學意義LSD-t=9.26、11.44、3.57,P均＜0.05].賁門久開和胃囊上壓跡齣現率:Ⅲ型組＞Ⅱ型組＞Ⅰ型組(80.0％、40.5％、4.8％,x2=11.64、29.76、8.59,P均＜0.05；91.4％、27.1％、4.8％,x2=30.69、40.73、4.32,P均＜0.05).His角變鈍(可從食管看到胃體)和疝囊齣現率:Ⅲ型組大于Ⅰ型組和Ⅱ型組(分彆為74.3％和77.1％,24.3％和24.3％,4.8％和4.8％;x2=17.97、25.41,P均＜0.05),Ⅰ型組和Ⅱ型組差異均無統計學意義(P均＞0.05).食管炎髮生率:Ⅲ型組和Ⅱ型組皆大于Ⅰ型組(71.4％,59.5％,14.3％；x2=17.14、11.15,P均＜0.05),Ⅲ型組和Ⅱ型組差異無統計學意義(P＞0.05).Barrett食管在:3組各1例.胃鏡診斷HH敏感度為91.4％,特異度為81.0％.結論 HH的胃鏡錶現中,EGJ與膈食管裂孔壓跡距離、賁門久開、His角變鈍、胃囊上壓跡及疝囊是比較重要的指標.胃鏡診斷HH敏感度較高,特異度偏低.
목적 분석하식관괄약기(LES)여격기분리환자적위경표현,탐구기재진단식관렬공산(HH)중적의의.방법 회고성분석2011년1월지2012년6월적고분변솔식관측압(HRM)환자자료,종중사선제시LES여격기분리적환자,배제상소화도수술사급결핍완정위경자료적병례,공93례납입분석.안지가가표준분성3조,Ⅰ형조(LES여격기분리＜1 cm)21례；Ⅱ형조(LES여격기분리1～＜2 cm)37례；Ⅲ형조(LES여격기분리≥2 cm) 35례.분석각조간위경표현차이.이HRM위금표준,계산위경진단HH적민감도、특이도.계량자료이(-x)±s표시,다조간균수비교채용단인소방차분석,량량비교채용LSD법혹Dunnett T3검험.량조간솔적비교채용잡방검험혹Fisher학절개솔법.결과 3조간위식관련접부(EGJ)여문치적거리차이무통계학의의(P＞0.05),이EGJ여격식관렬공압적적거리:Ⅲ형조[(3.57±0.78) cm]＞Ⅱ형조[(1.89±0.81) cm]＞Ⅰ형조[(1.14±0.67) cm],차이균유통계학의의LSD-t=9.26、11.44、3.57,P균＜0.05].분문구개화위낭상압적출현솔:Ⅲ형조＞Ⅱ형조＞Ⅰ형조(80.0％、40.5％、4.8％,x2=11.64、29.76、8.59,P균＜0.05；91.4％、27.1％、4.8％,x2=30.69、40.73、4.32,P균＜0.05).His각변둔(가종식관간도위체)화산낭출현솔:Ⅲ형조대우Ⅰ형조화Ⅱ형조(분별위74.3％화77.1％,24.3％화24.3％,4.8％화4.8％;x2=17.97、25.41,P균＜0.05),Ⅰ형조화Ⅱ형조차이균무통계학의의(P균＞0.05).식관염발생솔:Ⅲ형조화Ⅱ형조개대우Ⅰ형조(71.4％,59.5％,14.3％；x2=17.14、11.15,P균＜0.05),Ⅲ형조화Ⅱ형조차이무통계학의의(P＞0.05).Barrett식관재:3조각1례.위경진단HH민감도위91.4％,특이도위81.0％.결론 HH적위경표현중,EGJ여격식관렬공압적거리、분문구개、His각변둔、위낭상압적급산낭시비교중요적지표.위경진단HH민감도교고,특이도편저.
Objective To analyze the endoscopic features of patients with the lower esophageal sphincter (LES) and crural diaphragm (CD) separation and explore its significance in hiatus hernia (HH) diagnosis.Methods From January 2011 to June 2012,the data of patients underwent esophagus high resolution manometry (HRM) examination were retrospectively analyzed and of which the patients with LES-CD separation were selected.Patients who received digestive tracts operation or lack of complete endoscopic date were excluded.A total of 93 cases were enrolled for analysis.According to Chicago Criteria,the cases were divided into three groups.There were 21 cases in type Ⅰ group (LES-CD separation＜1 cm),37 cases in type Ⅱ group (LES-CD separation≥l cm and ＜2 cm),35 cases in type Ⅲ group (LES-CD separation≥2 cm).The differences among groups in endoscopic features were analyzed.HRM were taken as golden standard,the sensitivity and specificity of endoscopy in HH diagnosis were analyzed.Measurement data were expressed as x ± s,one-way ANOVA was performed for multi-groups comparisons,LSD method or Dunnett T3 test for pairwise comparisons and chi-square test or Fisher's exact test for two groups' comparisons.Results There were no significant differences in the distance between esophagus gastric junction (EGJ) and foreteeth of the three groups (P＞0.05).Distances between EGJ and diaphragmatic HH pressure impression in type Ⅲ group,type Ⅱ group and type Ⅰ group were (3.57±0.78) cm,(1.89±0.81) cm and (1.14±0.67) cm,respectively and the differences were significant (LSDt=9.26,11.44,3.57; all P＜0.05).The percentage of continuously-open cardia and showing pressure impression of the gastric pouch of type Ⅲ group was higher than that of type Ⅱ group and the percentage of continuously-open cardia and showing pressure impression of gastric poach of type Ⅱ group was higher than that of type Ⅰ group (80.0％,40.5％ and 4.8％,x2 =11.64,29.76 and 8.59; 91.4％,27.0％ and 4.8％,x2 =30.69,40.73 and 4.32' all P＜0.05).The occurrence rates of the His angle blunting and sac of type Ⅲ group were higher than those of typeⅡ group and type Ⅰ group (74.3％ and 77.1％,24.3％ and 24.3％,4.8％ and 4.8％,x2 =17.97 and 25.41,both P＜0.05),there was no significant difference between type Ⅱ group and type Ⅰ group (P＞0.05).The rates of esophagitis of type Ⅲ group and type Ⅱ group were higher than that of type Ⅰ group (71.4％,59.5％ and 14.3％,x2 =17.14 and 11.15,both P＜0.05),there was no significant difference between type Ⅲ group and type Ⅱ group (P＞0.05).There was one case of Barrett's esophagus in each group.The sensitivity and specificity of endoscopy in HH diagnosis were 91.4％ and 81.0％,respectively.Conclusions The distance between EGJ and hiatal pressure impression,continuously-open cardia,the His angle blunting,hiatal pressure impression of the gastric pouch and hernia sac were important indicators of HH endoscopic features.The sensitivity of endosocopy is higher than the spcificity of endosocopy in HH diagnosis.
