高分辨率食管测压下胃食管反流病患者胃食管连接处的特点分析  

The characteristics of the gastroesophageal junction in gastroesophageal reflux disease under high. resolution esophageal manometry

作　　者：郭晓军[1] 张玲[2] 林寒[2] 李兆申[2] 邹多武[2] 

机构地区：[1]济南军区青岛第二疗养院干部二科,青岛266071 [2]上海长海医院消化内科

出　　处：《中华消化内镜杂志》2015年第1期14-17,共4页Chinese Journal of Digestive Endoscopy

摘　　要：目的通过高分辨率食管测压（HRM）的方法探讨胃食管反流病（GERD）患者胃食管连接处（GEJ）的特点，以及GERD亚型反流性食管炎（RE）和非糜烂性反流病（NERD）患者的GEJ特点。方法60例GERD患者依据内镜检查结果阳性和阴性分为RE组（n=33）和NERD组（n=27），统一行HRM检测，并依据HRM下GEJ形态将GEJ分为Ⅰ型、Ⅱ型和Ⅲ型，分析各型GEJ的HRM检测结果以及各型GEJ中RE和NERD患者的HRM结果。结果Ⅰ型26例，其中RE患者14例、NERD患者12例；Ⅱ型29例，其中RE患者14例、NERD患者15例；Ⅲ型5例，均为RE患者。Ⅰ型的食管下括约肌（LES）总长度为（3．35±0．56）cm、腹腔内LES长度为（2．41±0．68）cm、LES静息压为（22．00±8．00）mmHg（1mmHg：0．133kPa），Ⅱ型分别为（3．29±0．87）cm、（3．07±4．59）cm和（16．46±8．60）mmHg，Ⅲ型分别为（2．43±0．22）cm、（0．00±0．00）cm和（11．07±5．80）mmHg，LES总长度各型间差异均有统计学意义（P〈0．05），腹腔内LES长度仅Ⅰ型与Ⅲ型间差异有统计学意义（P〈0．05），LES静息压各型间差异均无统计学意义（P〉0．05）。Ⅰ型、Ⅱ型中，RE与NERD患者在LES至膈肌角距离、LES总长度、腹腔内LES长度和LES静息压方面差异均无统计学意义（P〉0．05）。结论采用HRM可清楚分辨出GERD患者GEJ的不同亚型，各型GEJ的食管动力学特点有所不同，但受限于样本量未能进一步发现各型GEJ的RE与NERD患者间的食管动力学差异。Objective To analyze the characteristics of gastroesophageal junction（GEJ） in gastroe- sophageal reflux disease （GERD） using high resolution manometry （HRM） , and the features in different GERD subtypes, reflux esophagitis （RE） and non-erosive gastrooesophageal reflux disease （NERD）. Methods Sixty GERD patients were divided into two subtypes, RE （n = 33 ） and NERD （n = 27）, based on the results of endoscopy. All patients received HRM, and were divided into three subtypes, type Ⅰ , type Ⅱ and type Ⅲaccording to the GEJ pressure morphology. HRM results among different subtypes were investigated. Results In 60 GERD patients, the GEJ was divided into three subtypes, including 26 cases of type Ⅰ （ RE = 14, NERD = 12） , 29 cases of type Ⅱ （ RE = 14, NERD = 15 ） and 5 cases of type Ⅲ（ RE = 5 ）. The characteristics of GEJ morphologic subtypes were analyzed. The total length of lower esophageal sphincter（LES） of three GEJ subtypes（ type Ⅰ , type Ⅱand type m ） were （ 3.35 ±0. 56 ） cm, （ 3.29 ± 0. 87 ） cm and（2.43 ±0. 22 ）era, respectively. The LES intra-abdominal length of three GEJ subtypes were （2. 41 ±0. 68 ） era, （ 3.07 ± 4. 59） cm and（0.00 ±0. 00） cm, respectively. The LES rest pressure of three GEJ subtypes were（22. 00 ±8.00） mmHg, （ 16.46 ±8.60） mmHg and（ 11.07 ±5.80） mmHg, respectively. The total length of LES were significantly different among three subtypes （ P 〈 0. 05 ）. The LES rest pressure were not significantly different among three subtypes（ P 〉 0. 05 ）. Among type Ⅰ and type Ⅱpatients, there were no significant difference in LES-CD distance, total length of LES, LES intra-abdominal length and LES rest pressure between RE group and NERD group. Conclusion HRM can clearly distinguish the GEJ subtypes. To some extent, esophageal motility characteristics of the patients with different subtypes GEJ is various. However, it still needs further studies with larger sample size to confirm.

关 键 词：胃食管反流病 高分辨率测压 胃食管连接处 

分 类 号：R571[医药卫生—消化系统]