颈前路手术对食管压力的影响

【作者】 郑燕平； 李小斌； 刘新宇； 贾龙； 袁振灿； 韩世杰； 黎君彦；

【机构】 山东大学齐鲁医院骨科；

【摘要】 目的通过监测颈椎前路手术的病人手术前、后食管压力的变化,分析手术各因素对食管动力学及吞咽功能的影响。方法本组43例,其中男24例,女19例。年龄37～75岁,平均年龄53.5±4.38岁。接受全身麻醉者18例、颈丛麻醉25例。单节段手术5例,双节段22例,三节段10例,四节段6例。钛板固定29例,钛板联合椎间融合器6例,单独使用椎间融合器8例。利用多道水灌注式测压导管分别测定手术前、后食管压力的变化,分析年龄、性别、手术节段、手术牵拉时间、内固定物、麻醉方式对食管压力变化的影响。结果17例老年组患者(≥55岁)术后压力下降者4例(23.5%);26例中年组(<55岁)中术后压力下降者21例(80.8%),两组有显著性差异(P<0.05)。男性术后压力下降者14例(58.3%)、女性11例(57.9%),两组无显著性差异(P>0.05)。单节段术后压力下降者4例(80%);双节段17例(77.3%);三节段2例(20%);四节段2例(33.3%)。手术节段对食管压力变化有显著性影响(P<0.05)。短节段术后压力明显小于术前的压力。使用钛板者术后压力下降1 7例(58.6%);使用Reflex钛板+Cage 2例(33.3%);使用Cage者6例(75%)。内固定物的选择对食管压力变化无显著的影响(P>0.05)。接受全麻者术后压力下降7例(38.9%);颈丛麻醉18例(72%)。麻醉方式对手术前后食管压力有显著的影响(P<0.05)。结论年龄、手术节段及手术时间、麻醉方式对术后食管压力变化均有较显著影响,其机制可能为手术牵拉使食道横纹肌松弛,或食管壁局部缺血进而充血、水肿从而导致食道压力降低。由于前者对食道压力影响相对恒定,因而手术牵拉时间及力度与食道压力下降影响较大。更多还原

【Abstract】 Objective:The objective of this investigation was to analysis esophagus motility and swallowing function after anterior cervical discectomy and fusion(ACDF) by monitoring the change of esophageal pressure.Methods:43 cases who underwent ACDF were included in our study.There were 24 males and 19 females,with the mean age 53.5±4.38 years(range 37 to 75 years).Single-level surgery was performed in 5 cases, double-level surgery in 22,three-level in 10,and four-level in 6 cases.General anesthesia was performed in 18 cases and plexus anesthesia in 25 cases.Titanium-plate fixation was performed in 29 cases,titanium-plate and cages in 8,cages fusion in 6 cases.The pre-and post-operative esophageal manometry was measured.Results: There are 4 cases(23.5%) of older age-group(≥55) whose preoperative pressure was lower than post-operative’ s,and 21cases(23.5%) of middle age-group(<55) whose preoperative pressure was lower than postoperative(P<0.05).Preoperative pressure of fourteen males(58.3%) and 11 females(57.9%) was higher than postoperative pressure (P>0.05).The post-operative pressure of the patients who accepted single,double, three and four-level surgery was decreased in 4(80%),17(77.3%),2(20%),and 2 cases(33.3%),respectively(P<0.05).The post-operative pressure of the patients who accepted plate fixation,cage fusion or both was decreased in 17(58.6%),6 (75%) and 2 cases(33.3%),respectively.The post-operative pressure of 7 cases (38.9%) patients who accepted general anesthesia and 18 cases(72%) of plexus anesthesia was lower than those of post operative’ s(P<0.05).Conclusions:Age, number of surgical levels,time of traction,anesthesia methods significantly affected the esophagus motility.There maybe two reasons lead to the change of esophagus pressure.First the surgery traction lead to the striated muscle of UES relaxation, and the pressure of the esophagus degraded.Secondly,local ischemia of the esophagus wall lead to hyperaemia and edema,which make the pressure higher.The hyperaemia and edema had more dependability than the relaxation of striated muscle to the pressure change.更多还原