The mechanical basis of impaired esophageal emptying postfundoplication
The mechanical basis of impaired esophageal emptying postfundoplication
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DOI：
10.1152/ajpgi.00235.2004
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发表时间：
2005-07-01
影响因子：
4.5
通讯作者：
Brasseur, JG
中科院分区：
文献类型：
--
作者：
Ghosh, SK;Kahrilas, PJ;Brasseur, JG
胃底折叠术（FP）的功效是防止反流和因手术改变食管胃段内机械平衡而引起的术后吞咽困难之间的权衡。该研究的目的是定量对比正常食管排空和 FP 后食管排空之间的机械平衡。将生理数据与基于力学定律的数学模型相结合。七名正常对照 (NC) 和七名 FP 后患者同时接受测压和透视检查。在排空过程中对远端丸剂腔和食管裂孔几何形状的时间变化以及腔驱动压力进行量化。开发了数学模型，将腔内压力与食管裂孔几何形状和食管排空耦合起来，并确定腔内肌张力。我们发现 FP 后食管裂孔管的平均长度是 NC 的两倍；裂孔半径的减小并不显着。 FP 后所有食管排空事件均不完整（51% 保留）； NC 和 FP 后的排空时间没有显着差异，FP 后平均排空率低 40%。该模型预测食管排空过程中的三个不同阶段：食管裂孔打开（第一阶段）、准稳定期（第二阶段）和最终排空（第三阶段）。肌张力和驱动压力的快速增加迫使裂孔正常打开。 FP后，腔内肌张力严重受损，导致食管裂孔开口不足、流量和药丸滞留。我们得出的结论是，FP 后食管排空受损是由于远端食管肌肉无法快速产生必要的张力所致。外科手术对内括约肌的固定可能会导致这种缺陷、排空障碍，并可能导致吞咽困难。
Fundoplication ( FP) efficacy is a trade-off between protection against reflux and postoperative dysphagia from the surgically altered mechanical balance within the esophagogastric segment. The purpose of the study was to contrast quantitatively the mechanical balance between normal and post-FP esophageal emptying. Physiological data were combined with mathematical models based on the laws of mechanics. Seven normal controls (NC) and seven post-FP patients underwent concurrent manometry and fluoroscopy. Temporal changes in geometry of the distal bolus cavity and hiatal canal, and cavity-driving pressure were quantified during emptying. Mathematical models were developed to couple cavity pressure to hiatal geometry and esophageal emptying and to determine cavity muscle tone. We found that the average length of the hiatal canal post-FP was twice that of NC; reduction of hiatal radius was not significant. All esophageal emptying events post-FP were incomplete (51% retention); there was no significant difference in the period of emptying between NC and post-FP, and average emptying rates were 40% lower post-FP. The model predicted three distinct phases during esophageal emptying: hiatal opening ( phase I), a quasi-steady period ( phase II), and final emptying ( phase III). A rapid increase in muscle tone and driving pressure forced normal hiatal opening. Post-FP there was a severe impairment of cavity muscle tone causing deficient hiatal opening and flow and bolus retention. We conclude that impaired esophageal emptying post-FP follows from the inability of distal esophageal muscle to generate necessary tone rapidly. Immobilization of the intrinsic sphincter by the surgical procedure may contribute to this deficiency, impaired emptying, and possibly, dysphagia.