CAJ | 학술논문

目的：探讨胃食管反流病的高分辨率食管测压特点。方法回顾性分析2012年8月至2014年7月在新疆维吾尔自治区人民医院微创外科就诊，确诊为胃食管反流病患者的高分辨率食管测压结果，研究对象根据性别、年龄段、BMI分型、胃食管连接处形态等分别分组并进行对比分析。结果（1）男性患者食管下括约肌（LES）中心至鼻孔的距离较女性长，男性患者LES静息压力、LES残余压均低于女性患者，LES松弛率高于女性患者，差异有统计学意义（P＜0.05）。（2）不同年龄各组之间相关指标比较无统计学差异（P＞0.05）。（3）纳入本研究的400例胃食管反流病患者当中伴有偏胖及肥胖患者占62%，体重指数在正常范围或偏低者食管体部蠕动成功率约78%，偏胖及肥胖者食管体部蠕动成功率为68%。（4）胃食管反流病患者食管远段LES以上3、7、11 cm处压力及平均压力均比正常人降低，远端收缩积分（DCI）明显低于正常人，收缩前沿速度（CFV）、远段各节段蠕动波传导速度均大于正常人。（5）每个完整吞咽的分析，正常蠕动66.10%，失蠕动16.70%，小蠕动缺损9.60%，大蠕动缺损6.50%，快速同步收缩1.10%。（6）每位患者食管动力学的综合分析显示，蠕动正常162例，占40.50%，大缺损弱蠕动61例，占15.25%，小缺损弱蠕动72例，占18%，频发失蠕动85例，占21.25%，无蠕动12例，占3%，快速收缩/同步收缩8例，占2%。（7）根据胃食管连接处形态，51%伴有食管裂孔疝，LES与膈肌脚完全重叠率4.75%。结论胃食管反流病中男性的食管运动功能差于女性，食管动力学无年龄和体重相关差异性。胃食管反流病与正常人比较，LES 压力和食管体部运动功能明显降低，其中频发失蠕动、小缺损弱蠕动和大缺损弱蠕动为多见。胃食管反流病多伴有食管裂孔疝，因而LES功能明显降低。食管体部运动功能无食管裂孔疝相关差异性。目的：探討胃食管反流病的高分辨率食管測壓特點。方法迴顧性分析2012年8月至2014年7月在新疆維吾爾自治區人民醫院微創外科就診，確診為胃食管反流病患者的高分辨率食管測壓結果，研究對象根據性彆、年齡段、BMI分型、胃食管連接處形態等分彆分組併進行對比分析。結果（1）男性患者食管下括約肌（LES）中心至鼻孔的距離較女性長，男性患者LES靜息壓力、LES殘餘壓均低于女性患者，LES鬆弛率高于女性患者，差異有統計學意義（P＜0.05）。（2）不同年齡各組之間相關指標比較無統計學差異（P＞0.05）。（3）納入本研究的400例胃食管反流病患者噹中伴有偏胖及肥胖患者佔62%，體重指數在正常範圍或偏低者食管體部蠕動成功率約78%，偏胖及肥胖者食管體部蠕動成功率為68%。（4）胃食管反流病患者食管遠段LES以上3、7、11 cm處壓力及平均壓力均比正常人降低，遠耑收縮積分（DCI）明顯低于正常人，收縮前沿速度（CFV）、遠段各節段蠕動波傳導速度均大于正常人。（5）每箇完整吞嚥的分析，正常蠕動66.10%，失蠕動16.70%，小蠕動缺損9.60%，大蠕動缺損6.50%，快速同步收縮1.10%。（6）每位患者食管動力學的綜閤分析顯示，蠕動正常162例，佔40.50%，大缺損弱蠕動61例，佔15.25%，小缺損弱蠕動72例，佔18%，頻髮失蠕動85例，佔21.25%，無蠕動12例，佔3%，快速收縮/同步收縮8例，佔2%。（7）根據胃食管連接處形態，51%伴有食管裂孔疝，LES與膈肌腳完全重疊率4.75%。結論胃食管反流病中男性的食管運動功能差于女性，食管動力學無年齡和體重相關差異性。胃食管反流病與正常人比較，LES 壓力和食管體部運動功能明顯降低，其中頻髮失蠕動、小缺損弱蠕動和大缺損弱蠕動為多見。胃食管反流病多伴有食管裂孔疝，因而LES功能明顯降低。食管體部運動功能無食管裂孔疝相關差異性。
목적：탐토위식관반류병적고분변솔식관측압특점。방법회고성분석2012년8월지2014년7월재신강유오이자치구인민의원미창외과취진，학진위위식관반류병환자적고분변솔식관측압결과，연구대상근거성별、년령단、BMI분형、위식관련접처형태등분별분조병진행대비분석。결과（1）남성환자식관하괄약기（LES）중심지비공적거리교녀성장，남성환자LES정식압력、LES잔여압균저우녀성환자，LES송이솔고우녀성환자，차이유통계학의의（P＜0.05）。（2）불동년령각조지간상관지표비교무통계학차이（P＞0.05）。（3）납입본연구적400례위식관반류병환자당중반유편반급비반환자점62%，체중지수재정상범위혹편저자식관체부연동성공솔약78%，편반급비반자식관체부연동성공솔위68%。（4）위식관반류병환자식관원단LES이상3、7、11 cm처압력급평균압력균비정상인강저，원단수축적분（DCI）명현저우정상인，수축전연속도（CFV）、원단각절단연동파전도속도균대우정상인。（5）매개완정탄인적분석，정상연동66.10%，실연동16.70%，소연동결손9.60%，대연동결손6.50%，쾌속동보수축1.10%。（6）매위환자식관동역학적종합분석현시，연동정상162례，점40.50%，대결손약연동61례，점15.25%，소결손약연동72례，점18%，빈발실연동85례，점21.25%，무연동12례，점3%，쾌속수축/동보수축8례，점2%。（7）근거위식관련접처형태，51%반유식관렬공산，LES여격기각완전중첩솔4.75%。결론위식관반류병중남성적식관운동공능차우녀성，식관동역학무년령화체중상관차이성。위식관반류병여정상인비교，LES 압력화식관체부운동공능명현강저，기중빈발실연동、소결손약연동화대결손약연동위다견。위식관반류병다반유식관렬공산，인이LES공능명현강저。식관체부운동공능무식관렬공산상관차이성。
ObjectiveTo study high resolution manometric characteristics of gastroesophageal reflux disease. MethodsRetrospective analysis of high resolution manometry data of gastroesophageal reflux disease diagnosed at minimally invasive surgery department of People's hospital of Xinjiang Uygur Autonomous Region from August 2012 to July 2014 was performed. Comparatively study the data based on gender, age, BMI classification, morphology of gastroesophageal junction.Results(1)Comparison of different gender, resting pressure and residual pressure of LES are lower in male patients than female patients, LES relaxation rate higher in patients than female patients, the difference was statistically significant (P<0.05). Esophageal of body peristalsis associated parameters are not significantly different between genders. (2)Comparison between different age groups shows that associated parameters were no statistical differences between the groups (P>0.05). (3)400 patients included in this study with gastroesophageal reflux disease, overweight and obese patients accounted for 62%. (4)Compared with the normal, in patients with gastroesophageal reflux disease, with the pressure at 3 cm, 7 cm, 11 cm above LES, average pressure was lower. DCI was significantly lower than normal. CFV was greater than normal. Average duration of the peristalsis wave was shorter than normal. (5)Analysis of each swallowing, the normal peristalsis was accounting for 66.1%, aperistalsis was accounting for 16.7%, swallows with small breaks was accounting for 9.6%, swallows with large breaks was accounting for 6.5%, rapid contractions with normal latency was accounting for 1.1%. (6)Analyzed each patient, the normal peristalsis was accounting for 40.5%, weak peristalsis with large peristaltic defects was accounting for 15.25%, weak peristalsis with small peristaltic defects was accounting for 18%, frequent failed peristalsis was accounting for 21.25%, absent peristalsis was accounting for 3%, rapid contractions with normal latency was accounting for 2%. (7)According to morphology of gastroesophageal junction, typeⅠ was accounting for 4.75%, typeⅡ was accounting for 44.25%, typeⅢa was accounting for 48%, typeⅢb was accounting for 3%. 51% of GERD accompanied with hiatal hernia, completely overlapping rate of LES and diaphragm was accounting for 4.75%.ConclusionMale inferior to female in esophageal motor function, there is no difference of esophageal motility in gender and BMI classification. Compared to normal, LES pressure and motility function of esophageal body are significantly lower in gastroesophageal reflux disease, weak peristalsis with large and small peristaltic defects, frequent failed peristalsis are more common.