胃充盈超声在食管裂孔疝中的诊断价值

Diagnostic value of gastric filling ultrasonography in esophageal hiatus hernia

目的 探讨胃充盈超声(gastric filling ultrasonography,GFUS)对食管裂孔疝(esophageal hiatus hernia,EHH)的诊断价值。方法 回顾性分析2019年5月至2022年8月因反酸、烧心于首都医科大学附属北京友谊医院手术证实的32例EHH患者的术前GFUS结果,并与其同期上消化道内镜、高分辨率食管测压、食管阻抗p H检测、腹部计算机断层扫描(computed tomography,CT)及腹腔镜术中测量参数进行对比分析,探讨GFUS在EHH诊断中的价值。结果 (1)32例经手术证实的EHH患者术前同期GFUS、上消化道内镜、腹部CT及高分辨率食管测压对EHH的检出率依次为:81.3%、71.9%、31.3%及51.6%,GFUS对EHH的检出率高于腹部CT、上消化道内镜及高分辨率食管测压。(2)GFUS下测得的EHH疝囊平均径与术中测得的膈肌缺损径呈正相关(r=0.510,P=0.040);GFUS检出组与非检出组的膈肌缺损差异无统计学意义[5.0 (4.0,6.0)cm vs.4.0 (3.0,5.0)cm,P=0.103],腹部CT检出组膈肌缺损大于非检出组[5.5 (5.0,9.8)cm vs.4.3 (4.0,5.0)cm,P=0.018];(3)口服联合声诺维造影剂GFUS对EHH的检出率与口服胃窗造影剂组(93.8%vs.68.8%,P=0.086)差异无统计学意义。结论 GFUS尤其是联合声诺维造影剂的GFUS对EHH具有较高的检出率,且可评估EHH的分型及严重程度,有望成EHH患者的初步筛查手段。

Objective To explore the diagnostic value of gastric filling ultrasonography(GFUS)for esophageal hiatus hernia(EHH).Methods 32 patients with EHH confirmed by laparoscopic surgery were enrolled.Their preoperative GFUS characters were analyzed retrospectively,and compared with the parameters measured by upper gastrointestinal endoscopy(UGE),high resolution esophageal manometry(HREM),esophageal impedance pH measurement,computed tomography(CT)and laparoscopy at the same time,to explore the value of GFUS in the diagnosis of EHH.Results①The detection rate of EHH by GFUS,UGE,abdominal CT and HREM before operation in 32 patients with surgically proven EHH were 81.3%,71.9%,31.3%and 51.6%respectively.The detection rate of EHH by GFUS was higher than that by abdominal CT,UGE and HREM.②The mean diameter of EHH hernia sac measured by GFUS was positively correlated with the diameter of diaphragm defect,with correlation coefficient of r=0.510(P=0.040).The diameter of diaphragmatic defect measured during operation in the GFUS detected group was larger than that in the undetected group[5.0(4.0,6.0)cm vs.4.0(3.0,5.0)cm,P=0.103],however the difference was not statistically significant,and in the abdominal CT detected group was larger than that in the undetected group[5.5(5.0,9.8)cm vs.4.3(4.0,5.0)cm,P=0.018].③The detection rate of EHH by GFUS conducted under gastric contrast agent combined with SonoVue was higher than that by GFUS conducted under gastric contrast agent alone(93.8%vs.68.8%,P=0.086),but the difference was not statistically significant.Conclusions GFUS,especially combined with SonoVue contrast agent,has a high detection rate for EHH,and can evaluate the classification and severity of EHH,which is expected to become a preliminary screening method forEHH patients.