氩离子凝固术逆转Barrett食管上皮对其食管运动功能的影响

Effects of esophageal motility abnormalities in Barrett esophagus by argon plasma coagulation combined with proton pump inhibiter

目的了解Barrett食管上皮逆转前后食管体部运动功能的变化。方法对41例Barrett食管患者进行食管压力测定，筛选出食管体部运动障碍的Barrett食管患者22例，给予氩离子凝固术＋埃索美拉唑40mg／d治疗2～12个月，且内镜及病理证实Barrett食管上皮逆转后，再行食管压力测定，观察下食管括约肌静息压（LESP）及食管体部运动功能的变化。结果Barrett食管上皮逆转前后，LESP[（0．77±0．12）kPa比（0．80±0．13）kPa]、食管远端压力[（4．75±1．01）kPa比（5．04±0．91）kPa]、湿咽成功率[（48．0±5．4）％比（45．8±6．1）％]、传导速度[（3．0±0．9）cm／s比（3．1±0．9）cm／s]、蠕动时限[（3．1±1．1）8比（3．0±1．0）8]比较，差异均无统计学意义（P均〉0．05）；除传导速度和蠕动时限以外，其余指标均值仍显著低于对照组（P〈0．01）。结论Barrett食管上皮逆转后并不能提高LESP及改善食管体部的运动功能。食管体部运动功能障碍是Barrett食管的重要发病机制。

Objective To evaluate the effects of prolonged treatment with argon plasma coagulation（APC） and proton pump inhibiter on esophageal motility function in Barrett esophagus associated with peristaltic dysfunction. Methods Ten controls and 41 patients with Barrett esophagus. ALl patients underwent endoscopy, pathology and esophageal manometry. Twenty- two patients with Barrett esophagus and esophageal peristaltic dysfunction were included in the study group （APC group）. They received APC. Esomeprazole（40 rag/d） was given after the first APC application for two to twelve months until complete endoscopic and pathologic epithelial reversal were achieved. After epithelial reversal, a control esophageal manometry was then performed. Results In APC group, mean value of contraction amplitude was significantly lower than that of control group（ P 〈 0.01 ）, as well as, mean percentage of peristaltic contractions and value of lower esophageal sphincter pressure（LESP） （P 〈 0.01 ）. At the end of treatment, no a statistical/y significant improvement of esophageal motility function was observed for mean LESP[ （0.77 ±0.12） kPa vs（0.80 ± 0.13） kPa,P 〉 0.05] ,contraction amplitude[ （4.75 ± 1.01 ） kPa vs （5.04 ± 0.91 ） kPa, P 〉 0.05 ] , peristaltic contractions [ （ 48.0 ± 5.4 ） % vs （ 45.8 ± 6.1 ） %, P 〉 0.05 ] and peristaltic velocity [ （ 3.0 ± 0.9 ） cm/s vs （ 3.1 ± 0.9） cm/s, P 〉 0.05 ]. The post treatment values were still significantly lower than that in control values. Conclusion It is suggested that esophageal peristaltic dysfunction should he important role in the mechanism of Barrett esophagus.