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[肝硬化患者食管静脉曲张硬化治疗后食管的形态与功能]

[Morphology and function of the esophagus after sclerotherapy of esophageal varices in cirrhotic patients].

作者信息

Bretagne J F, Gosselin A, Le Jean-Colin I, Morisot D, Gastard J

出版信息

Gastroenterol Clin Biol. 1987 Jan;11(1):48-55.

PMID:3556959
Abstract

To assess the effects of endoscopic variceal sclerotherapy on esophageal symptoms and function, we prospectively studied 24 consecutive cirrhotic patients (group I), 60 days after variceal eradication had been achieved. Nine cirrhotics with varices (group II) and 16 normal volunteers (group III) were control groups. After sclerotherapy, 9 patients had persistent dysphagia and two others had heartburn. Nine patients developed an esophageal stricture, without dysphagia in 2 cases. Distal esophageal scars were observed in 8 out of 9 patients with stricture and 2 out of 15 patients without stricture. The percentage of patients with abnormal peristaltic waves (abnormal pattern, non propulsive contractions, respectively) was significantly (p less than 0.01) more important in group I (83 p. 100, 96 p. 100) than in group II (22 p. 100, 22 p. 100). A very particular manometric "en plateau" waveform pattern, never seen before, was observed in 75 p. 100 of patients in group I. Relaxation of lower esophageal sphincter (LES) was significantly (p less than 0.01) lower in patients with stricture (38 p. 100 median) than in the others (71 p. 100 median). Motility disturbances were observed in the 6 +/- 3 last centimeters of the esophagus, and were unchanged 9 months later in 5 patients who had further examination. The percentage of time below pH 4 and the Kaye's score did not differ between group I (n = 17) and group III on 3 hours postprandial esophageal pH monitoring. The percentage of time at pH less than 4 was more than 9 p. 100 in 31 p. 100 of group I patients.(ABSTRACT TRUNCATED AT 250 WORDS)

摘要

为评估内镜下静脉曲张硬化疗法对食管症状及功能的影响,我们对24例连续的肝硬化患者(第一组)进行了前瞻性研究,这些患者在静脉曲张根除后60天。9例有静脉曲张的肝硬化患者(第二组)和16名正常志愿者(第三组)作为对照组。硬化疗法后,9例患者持续吞咽困难,另外2例有烧心症状。9例患者出现食管狭窄,其中2例无吞咽困难。9例有狭窄的患者中有8例以及15例无狭窄的患者中有2例观察到食管远端瘢痕。第一组患者中蠕动波异常(分别为异常模式、非推进性收缩)的百分比(83%、96%)显著高于第二组(2%、2%)(p<0.01)。在第一组75%的患者中观察到一种前所未见的非常特殊的测压“平台期”波形模式。有狭窄的患者食管下括约肌(LES)松弛明显低于其他患者(p<0.01)(中位数分别为38%和71%)。在食管最后6±3厘米处观察到运动障碍,9个月后5例接受进一步检查的患者情况未变。餐后3小时食管pH监测中,第一组(n = 17)和第三组pH低于4的时间百分比及凯伊评分无差异。第一组31%的患者pH小于4的时间百分比超过9%。(摘要截选至250字)

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