腹腔镜抗反流手术前食管测压时多次快速吞咽的价值。
The value of multiple rapid swallows during preoperative esophageal manometry before laparoscopic antireflux surgery.
机构信息
Section of Minimally Invasive Surgery, Washington University School of Medicine, St. Louis, MO 63110, USA.
出版信息
Surg Endosc. 2012 Dec;26(12):3401-7. doi: 10.1007/s00464-012-2350-0. Epub 2012 May 31.
BACKGROUND
When multiple swallows are rapidly administered, esophageal peristalsis is inhibited, and pronounced lower esophageal sphincter relaxation ensues. After the last swallow of the series, a robust contraction sequence results. The authors hypothesize that multiple rapid swallows (MRS) may have value in predicting esophageal transit symptoms in patients undergoing laparoscopic antireflux surgery (LARS).
METHODS
Records of patients undergoing esophageal high-resolution manometry (HRM) before LARS were evaluated. The evaluation of MRS included adequate inhibitory response during swallows and the contraction pattern after MRS. Dysphagia was scored based on a product of symptom frequency and severity using 5-point Likert scales. A composite dysphagia score comprised the sum of scores for solid and liquid dysphagia, and a score of 4 or higher was considered clinically significant. The normal and abnormal MRS responses of patients with preoperative, early, and late postoperative dysphagia were compared with those of patients with no dysphagia.
RESULTS
In this study, 63 patients (mean age, 60.3 ± 1.7 years, 48 women) undergoing HRM before LARS successfully performed MRS (median, 5 swallows; longest interval between swallows, 3.2 ± 0.1 s). After MRS, 14 patients (22.2%) had an intact peristaltic sequence. Complete failure of peristalsis was seen in 21 (33.3%), and incomplete esophageal inhibition in 25 (39.7%) of the remaining patients. When stratified by presence or absence of dysphagia, 58.3% of the subjects without dysphagia had a normal MRS response, whereas 83.3% had formation of peristaltic segments after MRS. In contrast, only 14% of the subjects with dysphagia had a normal MRS response (p ≤ 0.003 vs. the subjects with no dysphagia). Abnormal MRS responses were more prevalent in the patients with any preoperative and late postoperative dysphagia (p = 0.04 across groups) and in those with clinically significant dysphagia (p = 0.08 across groups).
CONCLUSIONS
High-resolution manometry with MRS helps to predict dysphagia in subjects undergoing preoperative esophageal function testing before LARS.
背景
当快速吞咽多个吞咽时，食管蠕动会被抑制，继而出现明显的下食管括约肌松弛。在吞咽系列的最后一次吞咽后，会产生强烈的收缩序列。作者假设，多次快速吞咽（MRS）可能对预测腹腔镜抗反流手术（LARS）患者的食管转运症状有价值。
方法
评估了接受食管高分辨率测压（HRM）的 LARS 前患者的记录。MRS 的评估包括吞咽期间的充分抑制反应以及 MRS 后的收缩模式。根据 5 点 Likert 量表的症状频率和严重程度乘积对吞咽困难进行评分。固体和液体吞咽困难的评分之和构成复合吞咽困难评分，评分 4 或更高被认为具有临床意义。比较术前、早期和晚期术后吞咽困难患者与无吞咽困难患者的正常和异常 MRS 反应。
结果
在这项研究中，63 名（平均年龄 60.3±1.7 岁，48 名女性）接受 LARS 前 HRM 的患者成功进行了 MRS（中位数 5 次吞咽；最长吞咽间隔 3.2±0.1 s）。MRS 后，14 名患者（22.2%）有完整的蠕动序列。21 名患者（33.3%）完全丧失蠕动，25 名患者（39.7%）其余患者不完全抑制食管。根据是否存在吞咽困难进行分层，58.3%无吞咽困难的患者有正常的 MRS 反应，而 83.3%的患者 MRS 后形成蠕动段。相比之下，只有 14%的吞咽困难患者有正常的 MRS 反应（p≤0.003 与无吞咽困难的患者）。术前和晚期术后任何吞咽困难患者（组间 p=0.04）以及有临床显著吞咽困难患者（组间 p=0.08）异常 MRS 反应更为普遍。
结论
高分辨率测压结合 MRS 有助于预测接受 LARS 术前食管功能检查的患者的吞咽困难。
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