食管测压指导Nissen胃底折叠术31例

Value of intra- and postoperative manometry for Nissen fundoplication:an analysis of 31 cases

目的:评价食管下括约肌压力(LESP)、食管下括约肌总长度(LESL)在Nissen胃底折叠术中的监测价值.方法:2003-2007年利用食管测压指导短松式Nissen手术治疗滑动型食管裂孔疝31例.采用台式高分辨八通道胃肠动力监测系统液导法测定.对患者术前、术中及术后LESP和LESL、术后并发症、手术远期疗效等进行观察记录.结果:术中LESP较术前升高10-12mmHg.LESL较术前长1-1.5cm.术后随访2年以上,手术有效率96.5%.全组仅1例24hpH监测有明显酸反流,但无症状.结论:通过抗反流手术加术中测压,能够更准确判断胃底折叠缝合的松紧程度,有利于避免或减少术后并发症.

AIM： To evaluate the value of measurement of lower esophageal sphincter pressure （LESP） and lower esophageal sphincter length （LESL） for Nissen fundoplication （NF）. METHODS： Thirty-one patients with sliding hiatus hernia who underwent transabdominal surgery and intraoperative esophageal manometry from 2003 to 2007 were included. All the patients were followed up and subjected to manometry. RESULTS： During the procedure, the technician generally manipulated the probe several times and made sure that LESP would rise by 10-12 mmHg and LESL by 1.0-1.5 cm. During more than 2 years of follow-up, the effective rate was 96.5%. Only one patient had acid reflux during 24-h pH monitoring. CONCLUSION： If intraoperative esophageal manometry is performed during antireflux operation, side effects can be decreased to the least.Intraoperative manometry is useful in standardizing the tightness of the wrap in NF and in reducing or avoiding the occurrence of complications.