先天性食管裂孔疝患儿手术前后胃食管测压研究

Pre-and Post-Operative Study on Introesophageal and Introgastric Manometry in Infants with Congenital Esophagus Hiatus Hernia

对１５例先天性食管裂孔疝和１５例单纯性胃食管返流（ＧＥＲ）的患儿进行了胃、食管测压研究。结果：先天性食管裂孔疝合并ＧＥＲ的患儿食管下端括约肌（ＬＥＳ）压力及其与胃压差明显低于正常（Ｐ＜０．０５），术后仍有下降趋势。ＬＥＳ长度术后较术前延长。未合并ＣＥＲ的患儿术前ＬＥＳ压力与胃压差稍低于正常，术后压力明显下降，与正常组比较差异显著（Ｐ＜０．０５）。单纯性ＧＥＲ组ＬＥＳ压力及其与胃压差明显低于正常，而且年龄越小降低越明显，ＧＥＲ诱发试验８０％出现阳性。提示食管裂孔疝所致的解剖因素改变并不是发生ＧＥＲ的主要原因，ＬＥＳ压力也并不是衡量ＬＥＳ机能的唯一指标，对ＧＥＲ患儿的测压诊断在结合ＬＥＳ压力，长度和ＧＥＲ诱发试验进行综合分析。

esearches on intraesophageal and intragastric manometry were carried out in 15 cases with con-genital esophagus hiatus hernia and 15 cases with simple gastroesophageal reflux(GER).The resultsshowed that both LES pressure and the difference between LES pressure and gastric pressure in patientswith esophagus hiatus hernia complicated with GER were significantly lower than those in control group(P<0. 05).The pressure and pressure difference tended to decrease postoperatively with no significantdifference as compared with that preoperatively. There was no marked extension of high pressure zoneof LES although it extended slightly postoperatlvely, as compared with that preoperatively. The differ-ence between LES pressure and gastric pressure was slightly lower preoperatively than the normal val-ue, but they lowered much more postoperatively in the cases without GER. There was significant dif-ference as compared with the control group.The cases of simple GER were observed with much lowerLES pressure and smaller difference between gastric and LES pressure,u1e yOunger the infants,themore the pressure decreased, nd 80%of them were positive in GER in reduction test.All the resultsmentioned above showed that anatomic anomaly origiriated from hiatus hemia could not be considered asthe main cause of GER. The LES pressure could not be employed as the unique indicator to evaluateLES function. LES pressure, LES length, and GER induction test should be comprehended in mano-metric diagnosis of GER.