食管裂孔疝患者高分辨率食管测压的特点  

Characteristics of esophageal motility measured by high resolution esophageal manometry in hiatal hernia patients

作　　者：马欣[1] 彭丽华[1] 王潇潇[1] 艾洁[1] 郭志远[1] 杨云生[1] 

机构地区：[1]中国人民解放军总医院消化科,北京市100853

出　　处：《世界华人消化杂志》2016年第11期1718-1724,共7页World Chinese Journal of Digestology

摘　　要：目的:本研究通过高分辨率食管测压(high resolution esophageal manometry,HRM)方法分析食管裂孔疝患者食管动力变化的特点,为胃食管反流病的机制提供新的依据.方法:回顾性分析从2014-06/2015-04在中国人民解放军总医院消化动力中心行HRM且3mo内经胃镜诊断为食管裂孔疝的患者66例,其中,单纯食管裂孔疝患者35例,合并反流性食管炎者31例,另选取资料库中健康志愿者数据28例作为对照组,比较3组之间的临床资料和HRM数据.结果:35例单纯食管裂孔疝患者中,16例以反酸烧心为主诉前来就诊,12例以胸痛为主诉前来就诊,其余以吞咽困难、嗳气等症状前来就诊.行HRM后经2014新版芝加哥分型诊断,其中21例食管动力正常,4例有食管胃流出道梗阻,1例为重度食管动力障碍,9例为轻度食管动力障碍.31例合并反流性食管炎患者中,20例以反酸烧心为主诉前来就诊,6例以胸痛为主诉前来就诊,其余以吞咽困难、嗳气等症状前来就诊.行HRM后经2014新版芝加哥分型诊断,其中19例食管动力正常,2例有食管胃流出道梗阻,3例为重度食管动力障碍,10例为轻度食管动力障碍.以上结果在两组间的分布均无统计学差异(P>0.05).食管裂孔疝组下食管括约肌(lower esophageal sphincter,LES)静息压平均值显著低于健康对照组(P=0.016),尤其是合并反流性食管炎组LES静息压显著低于健康对照组(13.43 mmHg±8.75 mmHg vs 21.66 mmHg±7.19 mmHg,P=0.004).上食管括约肌(upper esophageal sphincter,UES)压力3组间数据并无统计学差异(P=0.854).然而,食管裂孔疝组患者UES静息压异常的发生率,尤其是UES低压的发生率显著高于健康对照组(25.7%vs 3.6%,P=0.041).结论:40%以上的食管裂孔疝患者存在食管体部动力障碍.相比健康人群,食管裂孔疝导致患者LES静息压显著降低,UES低压的发生率显著增高.异常的食管体部动力和降低的上下食管括约肌压力,可能是食管裂孔疝患者�AIM： To investigate the functional changeof esophageal motility in hiatal hernia（HH）patients using high resolution esophageal manometry（HRM）, in order to determine the possible pathogenesis of HH and provide more evidence for detection and treatment of HH.METHODS： We performed a retrospective study of 66 patients with hiatal hernia who underwent HRM from June 2014 to April 2015 as well as upper endoscopy and/or barium esophagogram within 3 mo at our hospital.Among them, 31 patients were diagnosed with reflux esophagitis（RE） by endoscopy. Besides,we selected 28 healthy volunteers as controls to compare clinical characteristics and HRM data between the three groups.RESULTS： In total there were 35 patients with HH alone（Group A）, of whom 16 had typical symptoms including acid reflux and heartburn, 12 suffered main symptoms resembling retrosternal pain, and the remainder had typical symptoms including dysphagia and belching. After HRM, 4 of them were diagnosed with esophagogastric junction（EGJ） outflow obstruction, 1 with severe esophageal motility disorder, and 9with mild esophageal motility disorder. In total there were 31 patients with RE（Group B）,of whom 20 had typical symptoms including acid reflux and heartburn, 6 suffered main symptoms resembling retrosternal pain,and the remainder had typical symptoms including dysphagia and belching. After HRM, 2 of them were diagnosed with esophagogastric junction（EGJ） outflow obstruction, 3 with severe esophageal motilitydisorder, and 10 with mild esophageal motility disorder. There was no significant difference in the above findings between groups A and B（P 〉0.05）. Lower esophageal sphincter（LES） pressure in groups A and B was significantly lower than that in the control group（P = 0.016）, especially group A（13.43 mmHg ± 8.75 mmHg vs 21.66 mmHg ±7.19 mmHg, P = 0.004）. Upper esophageal sphincter（UES） pressure had no significant difference among the three groups（P = 0.854）.However, the morbidity of UES hypotensive

关 键 词：食管裂孔疝 高分辨率食管测压 食管动力 食管上括约肌 食管下括约肌 

分 类 号：R571[医药卫生—消化系统]