Clouse R E, Staiano A, Alrakawi A, Haroian L
Division of Gastroenterology, Washington University School of Medicine, and Barnes-Jewish Hospital, St. Louis, Missouri 63110, USA.
Am J Gastroenterol. 2000 Oct;95(10):2720-30. doi: 10.1111/j.1572-0241.2000.03178.x.
Topographical manometric methods have improved the understanding of esophageal peristalsis in research applications but require a large number of recording sensors. Commonly used methods limited to four sensors were compared to topographical methods to determine whether the latter also had significant clinical utility.
Two hundred twelve patients referred for esophageal manometry were studied with a data acquisition system having 21 intraluminal recording sites, and the findings were analyzed independently using both limited (pull-through plus four recording sites) and topographical approaches (all sites). Discrepant results were clarified using supportive clinical data.
The two methods were in diagnostic agreement in 187 cases (88.2%). Topographical methods correctly identified all 26 patients with achalasia within the group with aperistalsis (n = 36). The limited methods could not confidently identify six achalasia patients and were significantly less effective in segregating aperistaltic disorders (p < 0.05 across methods). Topographical methods alone detected evidence of incomplete lower esophageal sphincter relaxation in 12 additional patients, eight of whom had clinical data supporting the findings. Topographical methods identified the upper margin of the lower sphincter in all but three subjects (1.4%); limited methods could not identify this location in these and five additional subjects (3.8%) and differed from the topographical measurement by > or = 2 cm in 11.9% of cases.
Topographical methods are more accurate than commonly used methods in diagnosing the type of severe motor dysfunction and provide additional information important in the clinical practice of esophageal manometry.
在研究应用中，腔内测压法提高了对食管蠕动的认识，但需要大量记录传感器。将常用的限于四个传感器的方法与腔内测压法进行比较，以确定后者是否也具有显著的临床实用性。
对212例因食管测压就诊的患者，使用具有21个腔内记录点的数据采集系统进行研究，并分别采用有限（牵拉法加四个记录点）和腔内测压法（所有记录点）独立分析结果。使用支持性临床数据明确不一致的结果。
两种方法在187例（88.2%）诊断中结果一致。腔内测压法正确识别了蠕动消失组（n = 36）中的所有26例贲门失弛缓症患者。有限方法无法确切识别6例贲门失弛缓症患者，在区分蠕动障碍方面效果明显较差（各方法间p < 0.05）。仅腔内测压法在另外12例患者中检测到食管下括约肌松弛不完全的证据，其中8例有支持该结果的临床数据。腔内测压法在除3例受试者（1.4%）外的所有受试者中识别出了下括约肌的上缘；有限方法在这些受试者及另外5例受试者（3.8%）中无法识别该位置，在11.9%的病例中与腔内测压测量值相差≥2 cm。
在诊断严重运动功能障碍类型方面，腔内测压法比常用方法更准确，并在食管测压的临床实践中提供了重要的额外信息。
