超声内镜联合高分辨率食管测压对难治性胃食管反流病患者下食管括约肌结构和运动功能异常的相关性分析

发布时间：2018-05-16 22:26

本文选题：内镜超声技术 + 胃食管反流　；参考：《中国内镜杂志》2015年09期

【摘要】：目的应用内镜超声(EUS)与高分辨率食管测压方法(HRM)检测难治性胃食管反流病(GERD)患者食管下括约肌(LES)结构与运动功能变化,探讨EUS在难治性GERD患者LES结构及运动功能异常评估中的有效性和可行性,以及LES厚度与压力间的关系。方法收集14例经内镜、24 h食管p H检测和经双倍剂量质子泵抑制剂(PPI)治疗8周疗效不明显,诊断为难治性GERD的患者,11例正常志愿者作为对照。运用EUS,记录LES的运动影像,测量LES的环形肌和纵形肌分别在不同时相的厚度;经鼻腔导入HRM测压导管,观察静息及吞咽时食管压力的变化,计算LES环形肌和纵形肌的收缩指数、收缩周期,计算LES基底压平均值与LES厚度间的相关性。结果 14例难治性GERD患者与正常对照组相比,LES的纵形肌厚度较薄(P0.05),而环形肌厚度差异无统计学意义(P0.05),环形肌与纵形肌收缩指数均明显缩小、收缩周期延长(P0.05);LES基底压平均值与最大肌层厚度之间存在正相关(r=0.62~0.70)。结论难治性GERD患者LES存在肌层结构与舒缩功能的异常;LES基底压平均值与最大肌层厚度间存在正相关,LES舒缩能力下降与难治性胃食管反流病的发病有直接关系;EUS获得LES的收缩指数、收缩周期为评估难治性胃食管反流病LES运动功能障碍具有一定的参考价值。
[Abstract]:Objective to detect the structure and motor function of lower esophageal sphincter (LES) in patients with refractory gastroesophageal reflux disease (GERD) by endoscopic ultrasonography (EUS) and high resolution esophageal pressure (HRM), and to explore the validity and feasibility of EUS in the assessment of LES structure and motor function abnormality in refractory GERD patients, and the relationship between the thickness of LES and the pressure between LES. The method was collected 14 cases of endoscopy, 24 h esophagus P H detection and double dose proton pump inhibitor (PPI) treatment for 8 weeks. The diagnosis of refractory GERD patients and 11 normal volunteers were used as control. Use EUS to record the motion images of LES, measure the thickness of LES's circular and longitudinal muscles at different phase, and introduce HRM pressure through the nasal cavity. The changes in the pressure of the esophagus during resting and swallowing were observed. The contraction index and the contraction cycle of the LES ring muscles and the longitudinal muscles were calculated. The correlation between the mean value of the LES base pressure and the thickness of LES was calculated. Results the thickness of the longitudinal muscle of LES was thinner than that of the normal control group (P0.05) in 14 cases of refractory GERD, but there was no statistical difference between the thickness of the circular muscle and the thickness of the circular muscle. P0.05, the contraction index of the ring muscle and the longitudinal muscle decreased obviously, the contraction period extended (P0.05); the mean value of the basal pressure of LES had a positive correlation with the thickness of the maximum muscular layer (r=0.62~0.70). Conclusion there was a positive correlation between the muscular layer structure and the abnormality of the systolic and contractile function in the refractory GERD patients, and there was a positive correlation between the mean value of the basal pressure of LES and the thickness of the maximum muscular layer, LES The decrease of systolic and diastolic ability has a direct relationship with the pathogenesis of refractory gastroesophageal reflux disease. The contraction index of LES and the contraction cycle of EUS have a certain reference value for evaluating the dysfunctional LES movement dysfunction of refractory gastroesophageal reflux disease.
【作者单位】：云南省第一人民医院暨昆明理工大学附属医院消化内科;
【基金】：云南省卫生科技计划基金(No:2012WS0066) 云南省科技计划基金(No:2013FZ184)
【分类号】：R571

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