Tamura S, Shiozaki H, Kobayashi K, Tahara H, Miyata M, Oka H, Mori T
Department of Surgery II, Osaka University Medical School, Japan.
Nihon Geka Gakkai Zasshi. 1992 Oct;93(10):1282-8.
Lower esophageal motility and mucosal hemodynamics were investigated in 20 patients who underwent transabdominal esophageal transection for esophageal varices (ET), to evaluate their association with reflux esophagitis and variceal recurrence. In the manometric study with microtransducer catheter, maximum swallowing pressure in the lower esophagus of the patients was significantly lower than that of the healthy controls (20 cases) (26.1 +/- 20.5mmHg vs. 80.0 +/- 10.0mmHg: p < 0.01), while high pressure zone pressure did not differ between the two groups. In comparison between patients with and without esophagitis (E(+) and E(-)), maximum swallowing pressure of E(+) was statistically lower than that of E(-) (12.4 +/- 18.7mmHg vs. 31.0 +/- 19.1mmHg: p < 0.05). In the hemodynamic study by reflectance spectrophotometry, the index of esophageal mucosal blood volume (IHb) and the index of oxygen saturation of hemoglobin (ISo2) of E(+) and E(-) were no different from those in the patients with non-operated esophageal varices (10 cases). Although there was no correlation between the recurrence of RC-sign and mucosal microcirculation, the patients with larger varices tended to have a higher IHb and a patients with F1-varices had significantly lower ISo2 than the patients without varices. This study indicated that the poor clearance ability after ET may lead to reflux esophagitis and the patients with variceal recurrence had the congested mucosal microcirculation, compared to those without variceal recurrence.
对20例因食管静脉曲张接受经腹食管横断术（ET）的患者进行了食管下段动力和黏膜血流动力学研究，以评估它们与反流性食管炎和静脉曲张复发的关系。在使用微型传感器导管的测压研究中，患者食管下段的最大吞咽压力显著低于健康对照组（20例）（26.1±20.5mmHg对80.0±10.0mmHg：p<0.01），而两组之间的高压区压力无差异。在有食管炎和无食管炎的患者（E(+)和E(-)）之间比较，E(+)的最大吞咽压力在统计学上低于E(-)（12.4±18.7mmHg对31.0±19.1mmHg：p<0.05）。在通过反射分光光度法进行的血流动力学研究中，E(+)和E(-)的食管黏膜血容量指数（IHb）和血红蛋白氧饱和度指数（ISo2）与未手术的食管静脉曲张患者（10例）无差异。虽然RC征的复发与黏膜微循环之间没有相关性，但静脉曲张较大的患者往往有较高的IHb，F1级静脉曲张患者的ISo2明显低于无静脉曲张的患者。这项研究表明，ET术后清除能力差可能导致反流性食管炎，与无静脉曲张复发的患者相比，有静脉曲张复发的患者黏膜微循环充血。
