Pandolfino John E, Curry Jennifer, Shi Guoxiang, Joehl Raymond J, Brasseur James G, Kahrilas Peter J
Department of Medicine, Northwestern University Medical School, Chicago, IL, USA.
Ann Surg. 2005 Jul;242(1):43-8. doi: 10.1097/01.sla.0000167868.44211.f0.
To study the mechanical characteristics of the esophagogastric junction (EGJ) of postfundoplication patients and compare them with previously reported data on normal subjects and GERD patients.
Eight normal subjects, 9 GERD patients, and 8 fundoplication patients were studied with concurrent manometry, fluoroscopy, and stepwise controlled barostat distention of the EGJ. The minimal barostat pressure required to open the EGJ during the interswallow period was determined. Thereafter, barium swallows were imaged in 5-mm Hg increments of intrabag pressure. EGJ diameter and length were measured at each pressure during deglutitive relaxation.
EGJ opening diameter during deglutitive relaxation was on average 0.5 cm greater in GERD patients compared with normal subjects and fundoplication patients (P < 0.05). EGJ opening pressure and opening diameter were comparable between normal subjects and fundoplication patients; however, the EGJ length was 32% longer in fundoplication patients.
Fundoplication restores distensibility of the EGJ to a level similar to normal subjects. Since trans-EGJ flow is related to EGJ length and EGJ diameter, these findings suggest that retrograde flow through the EGJ would be decreased by both a reduction in diameter and an increase in length of the EGJ.
研究胃底折叠术后患者食管胃交界处（EGJ）的力学特性，并将其与先前报道的正常受试者和胃食管反流病（GERD）患者的数据进行比较。
对8名正常受试者、9名GERD患者和8名胃底折叠术患者进行同步测压、荧光透视检查以及EGJ的逐步控制性恒压器扩张研究。确定吞咽间期打开EGJ所需的最小恒压器压力。此后，以袋内压力每增加5mmHg的增量进行吞钡造影成像。在吞咽性松弛期间，于每个压力下测量EGJ的直径和长度。
与正常受试者和胃底折叠术患者相比，GERD患者吞咽性松弛期间的EGJ开口直径平均大0.5cm（P<0.05）。正常受试者和胃底折叠术患者之间的EGJ开口压力和开口直径相当；然而，胃底折叠术患者的EGJ长度长32%。
胃底折叠术可将EGJ的扩张性恢复到与正常受试者相似的水平。由于经EGJ的流量与EGJ长度和EGJ直径相关，这些发现表明，EGJ直径减小和长度增加均会减少通过EGJ的逆流。
