胃镜检查和高分辨率食管测压及上消化道造影检查对代谢综合征合并食管裂孔疝的临床诊断价值研究  

Clinical Diagnostic Value of Gastroscopy,High-resolution Esophageal Manometry and Upper Gastrointestinal Contrast Examination for Hiatal Hernia in Metabolic Syndrome:a Comparative Analysis

作　　者：黎鑫 艾克拜尔·艾力[2] 阿力木江·麦斯依提[3] 王志[3] 蒋媛[3] 伊比提哈尔·买买提艾力 克力木·阿不都热依木[2,3,4] LI Xin;AIKEBAIER·Aili;ALIMUJIANG·Maisiyiti;WANG Zhi;JIANG Yuan;YIBITIHAER·Maimaitiaili;KELIMU·Abudureyimu(Graduate School,Xinjiang Medical University,Urumqi 830054,China;Institute of General Surgery and Minimally Invasive Surgery,People's Hospital of Xinjiang Uygur Autonomous Region,Urumqi 830011,China;Department of Minimally Invasive,Hernia and Abdominal Surgery,People's Hospital of Xinjiang Uygur Autonomous Region,Urumqi 830011,China;Clinical Research Center for Gastroesophageal Reflux Disease and Weight Loss and Metabolic Surgery,Xinjiang Uygur Autonomous Region,Urumqi 830011,China)

机构地区：[1]新疆医科大学研究生院,新疆维吾尔自治区乌鲁木齐市830054 [2]新疆维吾尔自治区人民医院普外微创研究所,新疆维吾尔自治区乌鲁木齐市830011 [3]新疆维吾尔自治区人民医院微创、疝与腹壁外科,新疆维吾尔自治区乌鲁木齐市830011 [4]新疆维吾尔自治区胃食管反流病及减重代谢外科临床研究中心,新疆维吾尔自治区乌鲁木齐市830011

出　　处：《中国全科医学》2022年第35期4406-4411,共6页Chinese General Practice

基　　金：国家自然科学基金资助项目(82060166)。

摘　　要：背景代谢综合征患者合并食管裂孔疝的诊断尚无“金标准”的检查方法,提高术前的检出率,对于制订合理的手术方式并且避免术后严重的并发症有重要意义。目的探究胃镜、高分辨率食管测压以及上消化道造影检查对代谢综合征合并食管裂孔疝的临床诊断价值。方法回顾性选取2021年9月至2022年4月新疆维吾尔自治区人民医院微创、疝与腹壁外科收治的代谢综合征合并胃食管反流并行手术治疗的患者55例,根据术中所见将患者分为代谢综合征合并食管裂孔疝组(复杂组,17例)和代谢综合征未合并食管裂孔疝组(单纯组,38例)。入院后完善胃镜检查、高分辨率食管测压、测酸以及上消化道造影检查,并采用Gerd Q评分量表进行测评。绘制不同检查方法诊断代谢综合征合并食管裂孔疝的受试者工作特征(ROC)曲线,并比较ROC曲线下面积(AUC)。结果复杂组胃镜诊断率、高分辨率食管测压诊断率、测压食管裂孔疝直径、上消化道造影检查诊断率、Gerd Q评分均高于单纯组,食管下括约肌静息压平均值(LESP)、Demeester评分均低于单纯组(P<0.05)。多因素Logistic回归分析结果显示,Demeester评分和上消化道造影检查是诊断代谢综合征合并食管裂管疝的影响因素(P<0.05)。ROC曲线结果显示,胃镜检查(AUC=0.728,P=0.007)、LESP(AUC=0.789,P=0.001)、Demeester评分(AUC=0.772,P=0.001)、上消化道造影检查(AUC=0.774,P=0.007)、Gerd Q评分(AUC=0.746,P=0.004)的AUC均>0.7,具有较高的临床诊断价值。结论胃镜检查、LESP、Demeester评分、上消化道造影检查和Gerd Q评分对代谢综合征合并食管裂孔疝具有较高的诊断价值。Background There is no a gold standard examination method for the diagnosis of hiatal hernia in patients with metabolic syndrome.Improving the preoperative detection rate of hiatal hernia is of great significance for formulating an appropriate surgical approach and avoiding severe postoperative complications.Objective To examine the diagnostic value of gastroscopy,high-resolution esophageal manometry and upper gastrointestinal contrast examination for hiatal hernia in metabolic syndrome.Methods Fifty-five patients with metabolic syndrome complicated with gastroesophageal reflux who were surgically treated in Department of Minimally Invasive,Hernia and Abdominal Surgery,People’s Hospital of Xinjiang Uygur Autonomous Region from September 2021 to April 2022 were retrospectively selected,including 17 with hiatal hernia found intraoperatively(complex group)and 38 without(simple group).The results of gastroscopy,high-resolution esophageal manometry,acid measurement,upper gastrointestinal contrast tests performed after admission and GERD-Q score were collected.Receiver operating characteristic(ROC)curves of these examination methods were plotted and the area under the ROC curve(AUC)was compared for estimating their diagnostic performance.Results Compared with simple group,complex group had higher diagnostic rates of gastroscopy,high-resolution esophageal manometry,greater manometric hiatal hernia diameter and upper gastrointestinal contrast examination,and higher Gerd-Q score(P<0.05).Complex group also had lower mean resting pressure of lower esophageal sphincter(LESP)and Demeester score(P<0.05).Multivariate Logistic regression analysis showed that Demeester score and findings upper gastrointestinal angiography were associated with the diagnosis of hiatus hernia in metabolic syndrome(P<0.05).ROC analysis indicated that all of gastroscopy(AUC=0.728,P=0.007),LESP(AUC=0.789,P=0.001),Demeester score(AUC=0.772,P=0.001),upper gastrointestinal contrast examination(AUC=0.774,P=0.007),Gerd-Q score(AUC=0.746,P=0.004)had an AUC

关 键 词：代谢综合征 疝 食管裂孔 上消化道造影 胃镜 高分辨率食管测压 诊断价值 

分 类 号：R655.4[医药卫生—外科学]