高分辨率食管测压法在食管裂孔疝诊断中的意义

Values of high resolution manometry in the diagnosis of hiatal hernia

目的评价高分辨率食管测压法在食管裂孔疝诊断中的临床价值。方法经腹腔镜下Toupet法胃底折叠术治疗术前经胃镜诊断合并有食管裂孑L疝的20例胃食管反流病患者，术前采用上消化道钡餐X线透视、高分辨率食管测压和24h食管pH监测检查，术中对食管裂孔情况进行观察。结果本组20例胃食管反流病患者经消化道X线钡剂造影诊断食管裂孔疝3例，高分辨率食管测压诊断食管裂孔疝9例，最终经术中确诊食管裂孔疝11例，其余9例排除食管裂孔疝。食管裂孔疝组和非食管裂孔疝组食管下括约肌长度分别为（1．92±0．38）cm和（2．10±0．92）cm（t=0．60，P〉0．05），食管下括约肌压力（呼吸最小值）分别为（0．64±0．55）kPa和（1．31±1．07）kPa（t=1．80，P〉0．05），食管下括约肌压力（呼吸平均值）分别为（1．43±0．92）kPa和（2．57±1．33）kPa（t=2．26，P〈0．05）。24h食管pH监测食管裂孔疝组酸性反流指数、pH≤4的总次数和DeMeester记分均高于非食管裂孔疝组（均P〈0．05）。消化道X线钡剂造影诊断与术中确诊食管裂孔疝符合者3例，符合率27％；胃镜诊断与术中诊断符合者11例，符合率55％；高分辨率食管测压诊断与术中诊断符合者9例，符合率82％。结论食管裂孔疝的食管抗反流屏障作用减弱，反流更严重；高分辨率食管测压诊断食管裂孔疝较胃镜及消化道X线钡剂造影更为准确。

Objective To evaluate high resolution manometry in the diagnosis of hiatal hernia. Methods Clinical data were reviewed on 20 patients suffering from gastroesophageal reflux who had laparoscopic Toupet fundoplication for preoperative tentative diagnosis of hiatal hernia. Preoperative diagnosis of hiatal hernia was made collectively by endoscopy, X-ray examination, 24 hour esophageal pH monitoring and high resolution manometry before surgery. Results Preoperative diagnosis of hiatal hernia was made in 3 patients by X-ray examination, in 9 patients by high resolution manometry. 11 patients were finally diagnosed with hiatal hernia intraoperatively. X ray was consistent with intraoperative diagnosis in 27% cases. Intraoperativc and endoscopic diagnoses were 55%. High resolution manometry and intraoperative diagnoses were consistent in 82%. Lower esophageal sphincter length was （ 1.92 ± 0. 38） cm in hiatal hernia group and （2. 10 ±0. 92） cm in non-hiatal hernia group （ t = 0. 60 ,P 〉 0.05 ） , lower esophageal sphincter pressure （respiratory rain） was （0. 64 ±0. 55） kPa in hiatal hernia group and （ 1.31 ± 1.07） kPa in nonhiatal hernia group（t = 1.80,P 〉 0. 05 ） , and lower esophageal sphincter pressure （ respiratory mean） was （ 1.43 ± 0. 92） kPa in hiatal hernia group and （ 2. 57 ± 1.33 ） kPa in non-hiatal hernia group （ t = 2. 26,P 〈 0. 05）. The reflux parameters, including the percent total time pH 〈 4, and DeMeester score, were significantly greater in hiatal hernia group than in non-hiatal hernia group （all P 〈 0.05 ）. Conclusions Hiatal hernia patients are with poor esophageal antireflux competency and severe reflux. High resolution manometrv is more valuable in the diagnosis of hiatal hrnia than endoscopy or X-ray examination.