贲门失驰缓症食管压力与诊断分类和手术方法的选择

Monitoring of Esophageal Pressure in Patients with Cardiac Achalasia: Its Significance in Diagnostic Classification and Surgical Management

手术治疗贲门失弛缓症８７例，其中３１例接受术前食管压力和／或２４小时食管ｐＨ检查；２６例兼行术中食管压力监护。结果显示食管下括约肌（ＬＥＳ）有接近正常吞咽松弛反应者占１３％，无吞咽松弛反应者８７％；食管体有原发吞咽运动者１３％，无吞咽蠕动８７％；高压区（ｈｉｇｈｐｒｅｓｓｕｒｅｚｏｎｅ，ＨＰＺ）值在正常范围者４／９例（４４．４％），呈高张力改变者５／９例（５５．６％）。揭示ＥＡ的运动紊乱类型存在明显差异，Ｐ＜０．０５～０．０１。对不同紊乱类型的手术方法和策略进行了讨论。

This paper presents the results and clinical significance of esophageal pressure monitoring in 57 out of 87 patients receiving surgical treatment for cardiac achalasia. In 31 cases preoperative 24 hour pH was determined and in 26 of them esophageal monitoring was performed during operation. The results demonstrated normal LES swallowing relax response in4/31(12.9%)and abnormal in 27/31(87%).Hypomotility disturbance patterns of the esophageal body in 27/31(87%)and hypermotility disturbance pattern in 12.9%.High pressure zong(HPZ)was increased in 5 patients(5/9,55%)and normal levels of HPZ in 4 patients(4/9,44.4%).The authors concluded the motility disturbances in cardiac achalasia were markedly variable in their patterns, P<0. 05,0.01.Surgical policy and procedures to be adopted by the pattern of motility disturbance.