摘要
目的 为探讨食管裂孔疝 (hiatalhernia ,HH)病理生理机制 ,了解HH患儿手术前后的食管功能改变及不同类型HH食管动力压力改变的特点。方法 对 38例经钡餐造影确诊的HH患儿(其中滑动型 17例、食管旁型 10例、混合型 11例 )进行手术前后 2 4小时食管pH监测和食管腔内动力压力测定。结果 食管裂孔疝患儿术前食管pH监测有明显的异常胃酸反流 ;食管动力压力异常表现为食道下段括约肌压力 (LESP)下降 ,下食管括约肌总长度 (LESL)变短 ,双峰波型出现及呼吸反转点消失。不同类型的食管裂孔疝食管动力压力的改变也有所不同 ,滑疝以双峰波型为主要改变 ;食管旁疝以呼吸反转点消失为主要改变 ;而混合疝以呼吸反转点消失及双峰波型为主要改变 ;LESL变短各类型疝都明显存在。术后食管pH监测各项指标均显著下降 ;食管腔内动力压力测定双峰波型消失 ,呼吸反转点出现 ,LESL增加 ,但LESP下降仍存在。结论 伴临床症状的HH患儿均存在明显的病理性胃酸反流 ;食管动力压力改变由于类型的不同而有所不同 ,LESP在HH反流的发生和抗反流的功能上不起重要作用 ,而LESL不足 ,尤其是腹内食管段长度不足甚至消失是HH发生反流的主要原因。
Objective This study was designed to understand the pathophysiology of hiatal hernia (HH) and to investigate the changes of esophageal function in children with HH before and after surgery and the difference of esophageal motility features among various types of HH. Methods Twenty-four-hr esophageal pH-metry by ambulatory pH monitoring (Synectics Digitrapper MK III) and esophageal manometry by low compliance capillary infusion system (PC Ploygraf HR) were studied in 38 cases (aged 2 months to 6 years old) with HH. The diagnosis of all these patients was confirmed by barium swallow, of whom 17 cases had sliding hernia, 10 had paraoesophageal hernia, 11 had mixed hernia. These examinations were repeated at 5-15 days after antireflux surgery. Results Esophageal pH-metry showed significant pathologic gastric acid reflux in patients with HH before operation. The abnormal changes of esophageal motility included lower esophageal sphincter pressure (LESP), short lower esophageal sphincter length (LESL), two high pressure zones (two-HPZ) in the distal esophagus and lack of respiratory inversion point (RIP). The changes of esophageal motility were different with the different types of HH: two-HPZ were found in patients with sliding hernia, disappearance of RIP occurred mainly in patients with paraesophageal hernia, while mixed hernia presented mostly both two-HPZ and lack of RIP. All the parameters of esophageal pH-metry decreased significantly postoperation. LESL increased significantly after operation, especially the intraabdominal length of LES. No significant difference in LESP was found after surgery compared to that of preoperation. RIP could be found again after operation, while two-HPZ in the distal esophagus disappeared. Conclusion Pathological gastric acid reflux was found in children with HH presented clinical symptoms. The changes of esophageal motility were different with the different types of HH. LESP was not an important factor in the episode of reflux and in the antireflux ability in HH. The decreased LESL, in particular, the intraabdominal length of LES or even in its absence was a major factor that determined the occurrence of reflux in children with HH.
出处
《中华儿科杂志》
CAS
CSCD
北大核心
2002年第3期135-137,共3页
Chinese Journal of Pediatrics
