滑动型食管裂孔疝伴反流性食管炎患者的食管动力学研究

Esophageal Motility in Patients with Sliding Hiatus Hernia and Reflux Esophagitis

目的：探讨滑动型食管裂孔疝（ＨＨ）伴反流性食管炎患者的食管动力学改变。方法：３０例经胃镜检查确诊的ＨＨ患者，根据食管炎程度分为ＨＨ１（食管炎Ａ～Ｂ级，ｎ＝１８）和ＨＨ２组（食管炎Ｃ～Ｄ级，ｎ＝１２），行食管钡餐检查证实为滑动型ＨＨ。在互线透视下观察食管粘膜增粗、狭窄、痉挛等形态学改变及反流与廓清方式，同时监测２４ ｈ食管ｐＨ、食管下括约肌（ＬＥＳ）压力以及反流期间食管蠕动的频率、幅度等情况。结果：３０例ＨＨ患者Ｘ线透视下均有食管粘膜增粗，反流以抽吸型为主（８０．０％），廓清以被动廓清为主（３６．７％）。２４ｈ食管ｐＨ监测中，ＨＨ组患者的总反流时间、卧位和立位反流时间百分比均显著高于对照组（Ｐ＜０．０１），但ＨＨ１和ＨＨ２组间无显著差异；ＨＨ组患者的ＬＥＳ静息压力显著低于对照组（Ｐ＜０．０５），ＬＥＳＫ度组问无明显差异山Ｈ组患者反流期间的食管体部蠕动频率和幅度均较对照组低，间期明显延长，ＨＨ２组患者的顺行性蠕动百分比亦较对照组明显降低（Ｐ＜０．０５）。结论：ＨＨ患者以抽吸型反流和被动廓清为主。食管酸暴露程度与食管炎严重度无关。ＬＥＳ静息压降低、反流期间食管蠕动频率。

Background Aims: To study the changes of esophageal motility in patients with sliding hiatus hernia (HH) and reflux esophagitis. Methods: 30 HH patients diagnosed with gastroscopy were divided into two groups by the degree of esophagitis (group HH1: grade A-B, n = 18; group HH2: grade C-D, n= 12) and sliding HH was confirmed by barium meal examination. Radiographic technique was used to as- sess the coarseness of mucosa, stricture and spasm, and to study the types of reflux and clearance. 24-hour esophageal pH monitoring and the lower esophageal sphincter (LES) pressure, the frequency and amplitude of esophageal peristalsis during the attack of reflux were also studied. Results: The radiography showed coarseness of mucosa, it was very common among all HH patients, and 80.0% of the cases showed the sucking type of reflux and 36.7% with passive clearance. The percentages of to- tal, supine and upright acid exposure time were greater in patients with HH than those in the controls (P<0.01), but the difference between HH1 and HH2 groups was not significant. LES resting pressure was lower in HH group than that in the control group (P< 0.05). However, there were no differences in length of LES among all groups. During the attack of acid reflux, the frequency, amplitude and percen- tage of esophageal peristalsis were lower in HH patients than those in the controls, and the duration of peristalsis was increased more than that of the controls (P<0.05). Conclusions: The sucking type of reflux and passive clearance are very important in HH. Esophageal acid exposure time does not cor- relate with the severity of esophagitis. Lowered LES resting pressure, decreased frequency and ampli- tude and increased duration of esophageal peristalsis during the attack of reflux may play an important role in the pathogenesis of sliding HH.