婴幼儿食管裂孔疝食管下括约肌功能研究

Function research of esophageal lower sphincter in infant with hiatal hernia

目的了解食管裂孔疝（ＨＨ）患儿胃食管动力与胃食管反流（ＧＥＲ）的关系以及评估手术疗效。方法１９９４～１９９６年对２６例经钡餐造影（ＧＩ）诊断的ＨＨ病儿（Ⅰ组：滑疝１６例，Ⅱ组：旁疝、混合疝共１０例），进行了手术前、后食管测压和２４小时食管ｐＨ监测。结果所有病儿均存在不同程度的ＧＥＲ，最长反流时间、总ｐＨ＜４的时间百分率以卧位更明显，术后各反流参数明显下降。两组术后均有食管下段括约肌长度（ＬＥＳＬ）显著增加和胃内压（ＧＰ）显著下降，Ⅰ组同时还伴食管下段括约肌压力（ＬＥＳＰ）和屏障压（ＢＰ）显著增加。６７％的Ⅰ组病儿和１４％Ⅱ组病儿术前测到双峰压。结论大多数婴幼儿ＨＨ的ＧＥＲ伴有ＬＥＳ功能低下和ＧＰ升高，胃食管动力改变与疝型有一定关系。手术保留一定长度的腹段食管至关重要，术后预防呼吸道感染是防止复发的重要措施。

Objective To investigate the relationship between gastroesophageal dynamics of infantile hiatal hernia(HH) and gastroesophageal reflux (GER) and to assess the curative effects of antireflux surgery. Methods Ambulatory 24 hr esophageal pH metry and esophageal manometry were studied in 26 patients with HH before and after surgery. Results By radiology, patients were divided into group of sliding HH( n =16,group Ⅰ) and group of para esophagael or combined HH( n =10,group Ⅱ).All patients showed GER. The duration of the longest episode,and the percentage of the time at pH<4 were significantly greater in lying position than those in upright position ( P <0 05). All parameters were significantly decreased after operation ( P <0 01).Lower esophageal sphinter length(LESL) increased significantly postoperatively. In group Ⅰ,lower esophageal sphincter pressure (LESP) and barrier pressure (BP) was increased after surgery, but no significant difference was seen in LESP and BP in group Ⅱ.Intragastric pressure (GP) significantly reduced after operation. GP in group Ⅱ before operation was higher than that in group Ⅰ( P <0 05). A second high pressure zone in the esophagus was found in 67% of patients in group Ⅰ and 14% patients in group Ⅱ. Conclusions Most patients with infantile HH and GER decreased LESL, LESP and increased GP. Differential gastroesophageal dynamics is associated with types of hiatal hernia. It is very important to remain enough LESL in mechanism of Dor antireflux surgery. To prevent respiratory infection is an important measure to prevent patients from relapse after surgery.