应用高分辨率测压研究不同亚型贲门失弛缓症患者的食管动力学特点

Characteristics of esophageal motility of different types of achalasia patients by high resolutionmanometry

目的探讨贲门失弛缓症患者高分辨率测压（HRM）结果的变化。方法收集24例贲门失弛缓症患者行HRM检测并分型，对不同亚型患者的食管压力测定数据进行分析。计数资料采用卡方检验，计量资料采用两独立样本t检验。结果24例贲门失弛缓症患者中，Ⅰ型5例，以男性为主；Ⅱ型18例，女性多于男性；Ⅲ型1例，为男性。Ⅰ型患者体质量减轻的发生率高于Ⅱ型（X^2=6．97，P=0．008），Ⅰ型患者胸痛和食物反流的发生率高于Ⅱ型，但差异无统计学意义（P均〉0．05）。电极插入胃腔的20例患者中，下食管括约肌（LES）上缘距鼻孔平均距离为（44．9±3．3）cm，LES下缘距鼻孔平均距离为（48．0±3．2）CiTI，LES平均总长度为（3．1±0．7）cm，腹腔内LES平均长度为（2．1±0．5）cm，LES平均静息压为（34．6±13．8）mmHg（1mmHg=0．133kPa），完整松弛压（IRP）为（31．1±12．0）mmHg。结论食管测压是贲门失弛缓症诊断的金标准，HRM可更加简便、直观和准确地检测食管功能。

Objective To investigate the dynamic changes in achalasia patients by using high resolution manometry （HRM）. Methods Twenty-four achalasia patients were enrolled for HRM examination and typing. The esophageal pressure of patients with different subtypes was analyzed. Chi-square test was used for count data analysis. Two independent samples t-test was used for measurement data. Results Among twenty-four achalasia patients, five patients were type Ⅰ and male- dominated, 18 patients were type Ⅲ and female was more than male, and only one male patient was type Ⅱ. The frequency of weight loss in type Ⅰ was higher than that of type Ⅱ （Z =6.97, P=0. 008）. The frequency of chest pain and food reflux in type I was higher than that of type Ⅱ （both P〉0.05）. The average distance from the nares to the upper edge of the lower esophageal sphincter （LES） with the electrode successfully inserted into the stomach was （44.9±3.3） cm and to the lower edge of the LES was （48.0±3.2） cm. The average LES length was （3. 1±0.7 ） cm, average intraabdominal LES length was （2. 1 ±0.5） cm. The average LES resting pressure was （34. 6±13.8） mm Hg （1 mm Hg= 0. 133 kPa） and the integrated relaxation pressure （IRP） was （31. 1± 12.0） mm Hg. Conclusion Esophageal manometry is the golden standard for achalasia diagnosis, and HRM may be a simple, direct-viewing and accurate method for accessing esophageal motor function.