Kawahara H, Nakajima K, Yagi M, Okuyama H, Kubota A, Okada A
Department of Pediatric Surgery, Osaka University Graduate School of Medicine, 2-2 Yamadaoka, Suita, Osaka, 565-0871 Japan.
Surg Endosc. 2002 May;16(5):767-71. doi: 10.1007/s00464-001-8228-1. Epub 2002 Feb 8.
In this study, we attempted to define the lower esophageal sphincter (LES) motor events associated with the occurrence of gastroesophageal reflux (GER) in neurologically impaired children in whom of GER disease recurred after laparoscopic Nissen fundoplication (LNF).
Of 45 neurologically impaired children who had previously undergone LNF, six children in whom recurrence of GER disease was documented by 24-h esophageal pH monitoring were studied. Concurrent esophageal manometry and pH monitoring were conducted for 1 h both before and after the administration of apple juice (10 ml/kg).
A total of 89 reflux episodes were recorded in the course of the study. Of these, 51 episodes (57%) were associated with transient LES relaxation. In the remainder, reflux occurred across a contracted LES in 21 episodes (24%) and during absent basal LES tone in 15 episodes (17%). In four of six patients, transient LES relaxation was responsible for more than half of the reflux episodes.
Transient LES relaxation is the predominant mechanism of reflux in neurologically impaired children with recurrent GER after LNF.
在本研究中，我们试图确定与神经功能受损儿童胃食管反流（GER）发生相关的食管下括约肌（LES）运动事件，这些儿童在腹腔镜Nissen胃底折叠术（LNF）后GER疾病复发。
在45名先前接受过LNF的神经功能受损儿童中，对6名经24小时食管pH监测记录到GER疾病复发的儿童进行了研究。在给予苹果汁（10 ml/kg）之前和之后，同时进行1小时的食管测压和pH监测。
在研究过程中总共记录到89次反流事件。其中，51次事件（57%）与LES短暂松弛有关。其余事件中，21次事件（24%）反流发生于LES收缩时，15次事件（17%）反流发生于LES基础张力消失时。在6名患者中的4名，LES短暂松弛导致了超过一半的反流事件。
LES短暂松弛是LNF后GER复发的神经功能受损儿童反流的主要机制。
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