Wallner G, Misiuna P, Dabrowski A, Abramowicz K, Polkowski W, Mijal M
Kliniki Chirurgii Ogólnej II Katedry Chirurgii Akademii Medycznej w Lublinie.
Wiad Lek. 1997;50 Suppl 1 Pt 1:282-92.
This prospective study was undertaken to assess the motility of the middle and lower esophagus and LES resting pressure changes following the N-R fundoplication for GER. The study was carried out in 53 consecutive patients (37 women, 16 men, median age 49.1 +/- 6.2 years), operated due to antireflux mechanism insufficiency. Threefold solid state for manometry and double channel for pH metry catheters in the body of the esophagus were used before and after the operation (median follow up time was 18 months). The LES length and resting pressure were evaluated with Synectics On-line interface. The objective results obtained during 24-h pH metry and manometry were shown as median and standard deviation, with statistical significances determined using the SPSS/PC+ packet (p < 0.05 considered as significant). The individual patients' data were analyzed by Synectics software. 24-h pH metry confirmed that Nissen-Rossetti fundoplication efficaciously reduced pathological GER (significant decrease of DeMeester score from 105.6 +/- 12.2 to 5.2 +/- 3.4, p < 0.0002). Manometry proved the increase of the LES resting pressure from 7.6 +/- 3.2 to 18.2 +/- 4.2, p < 0.0005, and its total length from 3.1 +/- 0.8 to 4.2 +/- 1.0, p < 0.01. The improvement of the esophageal body peristalsis was found first of all in total period. Motility changes following N-R fundoplication during the reflux period were unsatisfactory. The frequency of peristalic contractions with higher amplitude and longer duration significantly increased after the operation in total period in all levels. The increase of the complete peristaltic contractions following N-R fundoplication was high significant from 22.15% to 60.21%, p < 0.0001. Although significant improvement of the efficacy of esophageal peristalis was observed, however it was still under 50% of normal level all the time (15.4% v. 41.7%, p < 0.002). The most impressive improvement of esophageal peristalis was noticed in the lower part of the esophagus. The increase of the complete peristaltic contractions during the reflux period was observed only in upright position. Least profitable changes in esophageal body motility were noticed during the reflux period in supine position. In comparison with the total period manometry results the efficacy of the esophageal perystalsis during the reflux period was defected before as well as after the operation, (11.2% v. 22.5%, p = NS).
本前瞻性研究旨在评估N-R胃底折叠术治疗胃食管反流病（GER）后中下段食管的动力及LES静息压变化。该研究连续纳入53例患者（37例女性，16例男性，中位年龄49.1±6.2岁），均因抗反流机制不全接受手术治疗。术前及术后在食管体部使用三通道固态测压导管和双通道pH值监测导管（中位随访时间为18个月）。通过Synectics在线界面评估LES长度和静息压。24小时pH值监测和测压获得的客观结果以中位数和标准差表示，采用SPSS/PC+软件包确定统计学意义（P<0.05为有显著性）。个体患者数据通过Synectics软件进行分析。24小时pH值监测证实，Nissen-Rossetti胃底折叠术有效降低了病理性GER（DeMeester评分从105.6±12.2显著降至5.2±3.4，P<0.0002）。测压显示LES静息压从7.6±3.2升至18.2±4.2，P<0.0005，其总长度从3.1±0.8增至4.2±1.0，P<0.01。食管体蠕动的改善首先出现在整个时间段。N-R胃底折叠术后反流期的动力变化不理想。术后整个时间段各水平上，振幅更高、持续时间更长的蠕动收缩频率显著增加。N-R胃底折叠术后完全蠕动收缩的增加非常显著，从22.15%增至60.21%，P<0.0001。尽管观察到食管蠕动效率有显著改善，但始终仍低于正常水平的50%（15.4%对41.7%，P<0.002）。食管蠕动最显著的改善出现在食管下段。仅在直立位观察到反流期完全蠕动收缩增加。仰卧位反流期食管体动力变化最不理想。与整个时间段测压结果相比，术前及术后反流期食管蠕动效率均有缺陷（11.2%对22.5%，P无显著性）。
