胃镜下胃食管反流病评估新方法-食管裂孔横径法  

A new endoscopic approach for evaluation of gastroesophageal reflux disease-esophageal hiatus transverse diameter method

作　　者：田书瑞 陈冬 刘建军 刘健男 梁艳 吴继敏 Shu-Rui Tian;Dong Chen;Jian-Jun Liu;Jian-Nan Liu;Yan Liang;Ji-Min Wu(Department of Gastroesophageal Surgery,The PLA Rocket Force Medical Center,Beijing 100088,China)

机构地区：[1]中国人民解放军火箭军特色医学中心,北京市100088

出　　处：《世界华人消化杂志》2024年第8期576-583,共8页World Chinese Journal of Digestology

摘　　要：背景总结分析无法进行Hill分级因素,提出食管裂孔横径四级分级;收集胃镜、阻抗、测压等相关数据,通过与Hill胃食管阀瓣分级法比较,相关数据统计分析,证实胃镜下食管裂孔横径法在评估胃食管反流病中的价值.目的分析无法进行Hill分级因素及胃镜在胃食管反流病评估中的新方法.方法选择2019-03-07/2019-09-24在中国人民解放军火箭军特色医学中心胃食管外科就诊,考虑胃食管反流病并行胃镜检查患者749例.胃镜下进行Hill胃食管阀瓣分级,记录无法进行Hill分级因素,测量食管裂孔横径,收集反流性食管炎、下食管括约肌长度、压力,Demeester积分、反流次数等相关参数据,进行统计分析,比较Hill胃食管阀瓣分级法和胃镜下食管裂孔横径法在评估胃食管反流病中的价值.采用t检验、秩和检验、χ^(2)检验进行统计学比较.结果195例(195/749,26.03%)无法进行Hill分级.异常Hill胃食管阀瓣组和食管裂孔横径组,反流性食管炎发生率、食管裂孔横径、Demeester积分、反流次数增加,食管、食管下括约肌(lower esophageal sphincter,LES)、腹腔内LES长度均减短,LES静息压平均值、最小值均减低,差别有统计学意义(P<0.05);胃食管阀瓣组和食管裂孔横径组之间,在反流性食管炎发生率,Demeester积分、反流次数,食管、LES、腹腔内LES长度、压力差别均无统计学意义,有良好的一致性.结论客观存在一定无法进行Hill分级因素,胃镜下食管裂孔横径分级对胃食管反流病的评估有重要意义,简单易掌握,可以作为一种评价方法.BACKGROUND Factors that result in failed Hill grading were identified.A four-level classification approach,esophageal hiatus transverse diameter(EHTD)method,was proposed.Relevant data such as endoscopy,high resolution esophageal manometry,and esophageal impedance-pH monitoring were collected.By comparing with the gastroesophageal flap valve(GEFV)method,the value of the EHTD method in the assessment of gastroesophageal reflux disease(GERD)was verified.AIM To analyze factors that result in failed Hill grading and propose a new endoscopic method for evaluation of GERD.METHODS From March 7 to September 24 in 2019,749 patients with GERD who underwent endoscopic examination at the Department of Gastroesophageal Surgery,The PLA Rocket Force Medical Center were selected.The Hill grading of the GEFV was performed,and factors that were associated with failed Hill grading were recorded.The transverse diameter of the esophageal hiatus was measured under endoscopy,cases with reflux esophagitis were collected,and relevant data such as length and pressure of the lower esophageal sphincter(LES),reflux frequency,and Demeester score were collected in case that patients underwent high resolution esophageal manometry and(or)esophageal impedance-pH monitoring.The value of the GEFV method and EHTD method in the assessment of GERD was compared.The t-test,rank sum test,andχ^(2) test were used for statistical analyses.RESULTS A total of 195 cases(195/749,2603%)could not be graded by Hill’s classification.The proportion of patients with reflux esophagitis,the transverse diameter of the esophageal hiatus,reflux frequency,and Demeester score in normal group patients evaluated by the GEFV method and EHTD method were all signifi cantly higher than those of abnormal group patients,the minimum resting pressure and resting pressure of the LES were both significantly lower in abnormal group patients than in normal group patients,and the length of esophagus,LES,and intraperitoneal LES was significantly shorter in abnormal group patients than in

关 键 词：胃镜 胃食管反流病 胃食管阀瓣分级 食管裂孔横径分级 

分 类 号：R655.4[医药卫生—外科学]