CAJ | 학술논문

目的探讨Laimer纤维在贲门失弛缓症(AC)患者中的发生情况及其形态学特征.方法收集107例行经口内镜下肌切开术(POEM)治疗的AC患者的病例资料,重新筛查每例患者的POEM手术视频,根据患者性别、年龄段、AC内镜下Ling分型及Laimer纤维所在部位分类统计Laimer纤维发现率并行对比分析.结果 44例存在Laimer纤维,发现率为41.12％ (44/107).不同性别、不同年龄段AC患者中发现率比较差异均无统计学意义(P ＞0.05);LingⅡb型发现率最高(46.15％,12/26),其次为Ⅰ型(45.83％,22/48),Ⅲ型无发现,Ling各型发现率比较差异无统计学意义(x2=2.042,P=0.564);Laimer纤维均位于食管下段括约肌中,食管右侧壁发现率最高(36.45％,39/107),其次为食管左侧壁(3.74％,4/107),食管前壁无发现,食管各部位发现率比较差异有统计学意义(x2=107.468,P=0.000),但是食管不同部位黏膜隧道开口者发现率比较差异无统计学意义(x2=7.055,P=0.070).结论 Laimer纤维较为普遍存在于AC患者食管下段括约肌中,且多见于食管右侧壁,但与AC的发病关系以及对食管下段括约肌功能的影响尚需进一步研究验证.
목적 탐토Laimer섬유재분문실이완증(AC)환자중적발생정황급기형태학특정.방법 수집107례행경구내경하기절개술(POEM)치료적AC환자적병례자료,중신사사매례환자적POEM수술시빈,근거환자성별、년령단、AC내경하Ling분형급Laimer섬유소재부위분류통계Laimer섬유발현솔병행대비분석.결과 44례존재Laimer섬유,발현솔위41.12％ (44/107).불동성별、불동년령단AC환자중발현솔비교차이균무통계학의의(P ＞0.05);LingⅡb형발현솔최고(46.15％,12/26),기차위Ⅰ형(45.83％,22/48),Ⅲ형무발현,Ling각형발현솔비교차이무통계학의의(x2=2.042,P=0.564);Laimer섬유균위우식관하단괄약기중,식관우측벽발현솔최고(36.45％,39/107),기차위식관좌측벽(3.74％,4/107),식관전벽무발현,식관각부위발현솔비교차이유통계학의의(x2=107.468,P=0.000),단시식관불동부위점막수도개구자발현솔비교차이무통계학의의(x2=7.055,P=0.070).결론 Laimer섬유교위보편존재우AC환자식관하단괄약기중,차다견우식관우측벽,단여AC적발병관계이급대식관하단괄약기공능적영향상수진일보연구험증.
Objective To investigate the incidence,location and morphological features of Laimer fibers between mucosal layer and inner circular muscularispropria in patients with achalasia.Methods Data of 107 patients with achalasia who underwent POEM between May 2010 and June 2013 were collected.Endoscopic video was reviewed to determine the incidence of Laimer fibers and the corresponding images were analyzed according to gender,age,Ling typing and location of Laimer fibers.Results Laimer fibers were found in lower esophageal sphincter of 44 patients (41.12％).There were no significant differences in the incidences of Laimer fiber among groups with different age or gender (P ＞ 0.05).The incidence in Ling type Ⅱb was 46.15％ (12/26),and 45.83％ (22/48) in Ling type Ⅰ,0 in Ling type Ⅲ.There was no significant difference among the groups of Ling type (x2 =2.042,P =0.564).All Laimer fibers were found in lower esophageal sphincter and the majority of which were in right wall (36.45 ％,39/107),followed by left wall (3.74％,4/107) and none was found in anterior wall (x2 =107.468,P =0.000).Conclusion Laimer fibers generally exists in lower esophageal sphincter and most of which are discovered on right wall of the esophagus.Further study is needed to explore its role in development and treatment of achalasia.