高分辨率食管测压法在食管裂孔疝诊断中的意义.pdf

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1、中华普通外科杂志2013年6月第28卷第6期ChinJGenSurg，June2013，Vo1．28，No．6·427·．临床研究．高分辨率食管测压法在食管裂孔疝诊断中的意义季锋汪忠镐李震高翔张成超李治仝化召辉【摘要】目的评价高分辨率食管测压法在食管裂孔疝诊断中的临床价值。方法经腹腔镜下Toupet法胃底折叠术治疗术前经胃镜诊断合并有食管裂孑L疝的20例胃食管反流病患者，术前采用上消化道钡餐X线透视、高分辨率食管测压和24h食管pH监测检查，术中对食管裂孔情况进行观察。结果本组20例胃食管反流病患者经消化道X线钡剂造影诊断食管裂孑L疝3例，高分辨率食管测

2、压诊断食管裂孔疝9例，最终经术中确诊食管裂孔疝11例，其余9例排除食管裂孔疝。食管裂孑L疝组和非食管裂孔疝组食管下括约肌长度分别为(1．92±0．38)Cln和(2．10±0．92)cm(t=0．60，P>0．05)，食管下括约肌压力(呼吸最小值)分别为(0．64±0．55)kPa和(1．31±1．07)kPa(t=1．80，P>0．05)，食管下括约肌压力(呼吸平均值)分别为(1．43±0．92)kPa和(2．57±1．33)kPa(t=2．26，P<0．05)。24h食管pH监测食管裂孔疝组酸性反流指数、pH≤4的总次数和DeMeester记分均高于

3、非食管裂孔疝组(均P<0．05)。消化道X线钡剂造影诊断与术中确诊食管裂孔疝符合者3例，符合率27％；胃镜诊断与术中诊断符合者11例，符合率55％；高分辨率食管测压诊断与术中诊断符合者9例，符合率82％。结论食管裂孔疝的食管抗反流屏障作用减弱，反流更严重；高分辨率食管测压诊断食管裂孔疝较胃镜及消化道X线钡剂造影更为准确。【关键词】疝，食管裂孑L；测压法；胃食管反流ValuesofhighresolutionmanometryinthediagnosisofhiatalherniaJ／Feng，WANGZhong—gao，LIZhen，GA0Xiang，Z

4、HANGCheng—chao．L1Zhi—tong。HUAZhao—hui．DepartmentofInterventionalRadiology，theFirstAffiliatedHospitalofZhengzhouUniversity，Zhengzhou450052，ChinaCorrespondingauthor：WANGZhong—gao，E—mail：zhonggaowang@yahoo．eom【Abstract】objectiveToevaluatehighresolutionmanometryinthediagnosisofhiatal

5、hernia．MethodsClinicaldatawerereviewedon20patientssufferingfromgastr0esophagealrefluxwhohadlaparoscopicToupetfundoplicationforpreoperativetentativediagnosisofhiatalhernia．Preoperativediagnosisofhiatalherniawasmadecollectivelybyendoscopy，X—rayexamination，24houresophagealpHmonitori

6、ngandhighresolutionmanometrybeforesurgery．ResultsPreoperativediagnosisofhiatalherniawasmadein3patientsbyX—rayexamination，in9patientsbyhighresolutionmanometry．11patientswerefinallydiagnosedwithhiatalherniaintraoperatively．Xraywasconsistentwithintraoperativediagnosisin27％cases．Intr

7、aoperativeandendoscopicdiagnoseswere55％．Highresolutionmanometryandintraoperativediagnoseswereconsistentin82％．Loweresophagealsphincterlengthwas(1．92±0．38)eminhiatalherniagroupand(2．10-4-0．92)cminnon—hiatalherniagroup(t=0．60，P>0．05)，loweresophagealsphincterpressure(respiratorymin)w

8、as(0．64±0．55)kPainhiatalherniagroupand(1