Bowes K L, Sarna S K
Can J Surg. 1975 Jul;18(4):328-33.
The lower esophageal sphincter of 26 patients has been studied by infusion manometry before and after a modified Nissen fundoplication. Of these patients, 24 have remained asymptomatic (mean follow-up, 21 months). The mean time for a positive acid infusion test increased from 267 seconds before, to 617 seconds after operation. The common cavity test was positive in 22 of the 26 patients before operation but positive in only the 2 symptomatic patients after operation. Mean lower esophageal sphincter pressure (cm H20) increased from 12.6 +/- 2.0 to 16.5 +/- to 1.5 (x +/- SEM). However, in only 15 of the 26 patients was an increase in lower esophageal sphincter pressure demonstrated and in 7 a decrease in pressure was noted. One patient's symptoms recurred at 3 months in spite of an increase in lower esophageal sphincter resting pressure of 8 cm H20. The other symptomatic patient demonstrated a rise in lower esophageal sphincter pressure at 3 months of 8 cm H20, though this decreased to preoperative levels at 26 months, the time of symptom recurrence. Intraluminal pressure of the human cadaver esophagus after removal from the body was studied by means of an infusion manometric technique. Narrowing the esophageal lumen with extrinsic weight of as little as 50 g resulted in a zone of elevated pressure. The amplitude of the elevated pressure zone was directly related to the infusion rate. Elevations in lower esophageal pressure following fundoplication are probably secondary to extrinsic compression and are not necessary for a good clinical result.
对26例患者在改良Nissen胃底折叠术前后通过灌注测压法研究了食管下括约肌。这些患者中，24例仍无症状（平均随访21个月）。酸灌注试验阳性的平均时间从术前的267秒增加到术后的617秒。26例患者中，22例术前共同腔试验阳性，但术后仅2例有症状的患者试验阳性。食管下括约肌平均压力（厘米水柱）从12.6±2.0增加到16.5±1.5（x±标准误）。然而，26例患者中只有15例食管下括约肌压力升高，7例压力降低。1例患者尽管食管下括约肌静息压力升高了8厘米水柱，但3个月时症状复发。另1例有症状的患者在3个月时食管下括约肌压力升高了8厘米水柱，但在26个月症状复发时降至术前水平。通过灌注测压技术研究了人体尸体食管离体后的腔内压力。用低至50克的外部重量使食管腔变窄会导致压力升高区。压力升高区的幅度与灌注速率直接相关。胃底折叠术后食管下压力升高可能继发于外部压迫，且良好的临床结果不一定需要压力升高。
