【摘要】 目的分析内镜阴性但符合高分辨率测压(high resolution manometry,HRM)食管裂孔疝(hiatal hernia,HH)诊断标准的患者的临床特点。方法回顾性分析2010年9月-2016年4月北京大学第三医院行HRM检查患者的资料,纳入符合HH测压诊断且完善胃镜检查的患者共62例,全部患者接受症状调查,其中31例患者完成24 h食管阻抗-p H监测,根据胃镜是否诊断为HH分为内镜阳性(E+)组与内镜阴性(E-)组,分别比较两组患者的临床特点。结果 62例患者中,内镜诊断HH的患者共13例(E+),内镜未见HH表现的患者共49例(E-)。(1)临床症状:反酸、烧心、胸痛、吞咽困难、恶心、呕吐、腹痛、嗳气、咳嗽、胸部不适、打鼾等症状阳性率在两组间差异无统计学意义(P>0.05)。(2)内镜下食管表现:E+组的反流性食管炎(reflux esophagitis,RE)阳性率(69.2%)及Barrett’s食管(Barrett’s esophagus,BE)检出率(44.9%)均高于E-组,差异无统计学意义(P=0.119)。(3)HRM测压:E+组较E-组疝囊长度更长,但差异无统计学意义(P=0.088);食管下括约肌(low esophageal sphincter,LES)静息压、LES残余压、LES松弛率等食管下括约肌参数无显著性差异,而远端收缩积分(distal contractile integral,DCI)、收缩前沿速度(contractile front velocity,CFV)、远段收缩延迟时间(distal latency,DL)等食管体部蠕动收缩指标方面差异无统计学意义(P>0.05)。(4)24 h阻抗-p H监测:E+组患者病理性酸反流检出率略高于E-组患者,但差异无统计学意义(P=0.369)。疝囊长度则与患者De Meester积分、酸反流时间、酸反流次数及长酸反流次数等酸反流相关性指标呈显著正相关。结论 HRM对于HH的检出率敏感度高于胃镜,24 h食管阻抗-p H监测结果与胃镜检查结果存在一致性,对于有反酸、烧心、胸痛等症状的患者,若胃镜及24 h食管阻抗-p H监测未发现明显异常,尚可通过HRM进一步排查HH以提高疾病诊断率。更多还原

【Abstract】 Objective To analyze the clinical characteristics of hiatal hernia( HH) patients diagnosed by high resolution manometry( HRM) with negative endoscopic results. Methods Clinical datas of 62 patients from Sep. 2010 to Apr. 2016 who were diagnosed HH by HRM in Peking University Third Hospital were analyzed retrospectively,all the patients did symptoms investigation,31 cases of them underwent 24 hour-multichannel intraluminal impedance-p H monitoring( MII-p H). The patients were divided into endoscopic positive( E +) group and endoscopic negative( E-)group. Results There were 13 patients in E + group and 49 patients in E-group.( 1) Clinical symptoms: there were no significant differences in relevance ratio about acid reflux,heartburn,chest pain,dysphagia,nausea,vomit,abdominal pain,belch,cough,chest discomfort or snore between E + group and E-group.( 2) Endoscopic characteristics of esophagus: the relevance ratios of reflux esophagitis( RE)( 69. 2%) and Barrett’s esophagus( BE)( 44. 9%) by gastroscopy in E + group were both higher than E-group with no significant difference( P = 0. 119).( 3) HRM: the lengths of HH in E + group were longer than that in E-group although there was no significant difference( P =0. 088). There were no significant differences about low esophageal sphincter( LES) resting pressure including LES residual pressure and LES relaxation rate,there were no significant differences about distal contractile integral( DCI),contractile front velocity( CFV),or distal latency( DL) either.( 4) MII-p H: the relevance of pathological acid reflux in E + group was higher than that in E-group,while there was no significant difference( P = 0. 369). The lengths of HH were associated positively with acid associated indexes including De Meester score,the time of acid reflux,frequency of acid reflux and frequency of long acid reflux. Conclusion HRM has a higher sensitivity on diagnosing HH than endoscopy. The HRM and MII-p H have consistency in diagnosing acid reflux. Diagnosing rate of HH can be enhanced by HRM for patients with acid reflux,heartburn or chest pain with no abnormality of endoscopy and MII-p H examination.更多还原