Zaninotto G, Costantini M, Anselmino M, Boccù C, Bagolin F, Polo R, Ancona E
Department of Surgery, University of Padova, School of Medicine, Italy.
Eur J Surg. 1995 Apr;161(4):241-6.
To compare the competence of the lower oesophageal sphincter after Nissen fundoplication with that in a control group of healthy volunteers using a new computerized manometric device that integrates the pressure and length of the entire sphincter into one measurement, called the vector volume.
Open study.
University hospital, Italy.
18 patients, 6-52 months (mean 10 months) after they had undergone Nissen fundoplication for gastro-oesophageal reflux, and 14 healthy volunteers.
Oesophageal computerised manometric system comprising a catheter with eight side holes radially oriented to each other at 45 degrees on one level and 24-hour oesophageal pH monitoring.
Differences in percentage time of oesophageal acid exposure, number of episodes of gastro-oesophageal reflux, and lower oesophageal sphincter vector volume.
The pH of the oesophagus was returned to the normal range in all patients after the Nissen fundoplication. There was a significant reduction in both the percentage time of acid exposure and the number of episodes of gastro-oesophageal reflux compared with the control group (p < 0.001). The vector volume of the intra-abdominal part of the lower oesophageal sphincter was significantly increased compared with the control group (p < 0.04). Lower oesophageal sphincter pressure measured at the respiratory inversion point, and lower oesophageal length, both increased after fundoplication to become similar to control values. When sphincter pressure was measured as a mean of the sphincter pressure curve there was a clear difference postoperatively compared with controls (p < 0.02).
Nissen fundoplication corrects abnormal gastro-oesophageal reflux but abolishes normal physiological postprandial reflux; this is caused by the gastric fundus that encircling the intra-abdominal oesophagus, restores sphincter pressure and length, and modifies its shape.
使用一种新型计算机测压装置，该装置将整个括约肌的压力和长度整合为一个测量值，即矢量容积，比较尼氏胃底折叠术后食管下括约肌的功能与健康志愿者对照组的情况。
开放性研究。
意大利大学医院。
18例因胃食管反流接受尼氏胃底折叠术6至52个月（平均10个月）的患者，以及14名健康志愿者。
食管计算机测压系统，包括一根在同一水平上有八个相互呈45度径向排列侧孔的导管，以及24小时食管pH监测。
食管酸暴露时间百分比、胃食管反流发作次数以及食管下括约肌矢量容积的差异。
尼氏胃底折叠术后所有患者的食管pH值均恢复到正常范围。与对照组相比，酸暴露时间百分比和胃食管反流发作次数均显著降低（p<0.001）。食管下括约肌腹内部分的矢量容积与对照组相比显著增加（p<0.04）。在呼吸反转点测量的食管下括约肌压力以及食管下长度，在胃底折叠术后均增加，变得与对照值相似。当将括约肌压力作为括约肌压力曲线的平均值测量时，术后与对照组相比有明显差异（p<0.02）。
尼氏胃底折叠术纠正了异常的胃食管反流，但消除了正常的餐后生理性反流；这是由环绕腹内食管的胃底恢复括约肌压力和长度并改变其形状所致。
