肝硬化患者胃肠动力学研究进展

Advances in the study of gastrointestinal motility in patients with hepatic cirrhosis

肝硬化患者胃肠动力改变主要表现为食管运动功能下降，食管下段括约肌（ＬＥＳＰ）压力下降，其原因可能是受食管静脉曲张产生的机械因素影响及肝功能受损。胃排空延迟，主要原因为自主神经系统功能损害，胃肠激素代谢紊乱，可能与肝功能受损程度无关。小肠消化间期移行复合运动（ＭＭＣ）Ⅱ期延长，Ⅲ期缩短，使食物通过小肠时间延长。肝硬化门脉高压症合并食管静脉曲张破裂出血，硬化剂注射治疗后食管运动功能减弱，蠕动波数目减少，并诱发同时性收缩及双相收缩等异常收缩，食管酸清除率下降。套扎治疗较硬化剂治疗对食管动力影响小，主要表现为食管运动功能减弱，食管下段括约肌松弛率下降。另外。

Gastrointestinal motility abnormalities in patients with hepatic cirrhosis are mainly decrease in esophageal peristaltic function and decrease in lower esophageal sphincter (LES) pressure. These might be related to mechanical changes caused by esophageal varices and dysfunction of liver. Delayed gastric emptying, caused by dysfunction of autonomic nervous system and abnormalities in gastrointestinal hormone metabolism, has no relation to liver function. Prolonged duration of phase Ⅱ in small bowel migrating motor complex(MMC), and shortened phaseⅢresulted in prolongation of time of food passing through small bowel. Sclerotherapy for esophageal varices can have impact on esophageal motility, reduce the number of peristaltic waves, induce simultaneous contractions and biphasic contractions, and decrease acid clearence. Band ligation has less effect on esophageal motility than sclerotherpy, but it also causes dysfunction of esophageal motility and decreases LES relaxation percentage. On the other hand, changes in gastrointestinal hormone metabolism also have influence on gastrointestinal motility.