Hill L D
J Thorac Cardiovasc Surg. 1978 Mar;75(3):378-82.
The lower esophageal sphincter pressure has been measured intraoperatively in 200 patients with gastroesophageal reflux and in three patients with achalasia. Lower esophageal sphincter pressure is measured before and during repair. Calibrating the cardia during performance of the median arcuate posterior gastropexy allows a sphincter pressure between 50 and 57 mm. Hg to be obtained at operation. The postoperative pressures have ranged between 15 and 25 mm. Hg, or approximately half of the intraoperative pressure. No patient with a spincter pressure of 15 mm. Hg or greater has reflux according to postoperative pH and pressure studies. Correction of reflux correlates well with relief of symptoms. Three patients with achalasia had intraoperative manometrics during myotomy. The lower esophageal sphincter pressure was lowered and the length of the lower esophageal sphincter was shortened. Dysphagia was corrected without producing reflux. This is the first report of measurement of lower esophageal sphincter pressure in anesthetized patients. Intraoperative measurement of sphincter pressure is a safe, simple, and reliable technique which allows the surgeon, for the first time, to determine the status of the lower esophageal sphincter during the operation. This technique should be standard for all operations on the gastroesophageal junction.
已对200例胃食管反流患者和3例贲门失弛缓症患者在术中测量了食管下括约肌压力。在修复手术前后测量食管下括约肌压力。在进行正中弓状后胃固定术时校准贲门，可在手术中获得50至57毫米汞柱之间的括约肌压力。术后压力在15至25毫米汞柱之间，约为术中压力的一半。根据术后pH值和压力研究，括约肌压力在15毫米汞柱或更高的患者均无反流。反流的纠正与症状的缓解密切相关。3例贲门失弛缓症患者在肌切开术中进行了术中测压。食管下括约肌压力降低，食管下括约肌长度缩短。吞咽困难得到纠正，且未产生反流。这是关于在麻醉患者中测量食管下括约肌压力的首次报告。术中测量括约肌压力是一种安全、简单且可靠的技术，首次使外科医生能够在手术过程中确定食管下括约肌的状态。这项技术应成为所有胃食管交界手术的标准操作。
