IMPAIRMENT OF ESOPHAGEAL EMPTYING WITH HIATAL-HERNIA
IMPAIRMENT OF ESOPHAGEAL EMPTYING WITH HIATAL-HERNIA
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DOI：
10.1016/0016-5085(91)80003-r
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发表时间：
1991-03-01
期刊：
影响因子：
29.4
通讯作者：
KAHRILAS, PJ
中科院分区：
文献类型：
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作者：
SLOAN, S;KAHRILAS, PJ
应用同步视频透视和测压技术对22例轴型裂孔疝患者和14例健康志愿者的吞钡过程中的食道排空情况进行了分析。受试者被分成三组：(A)志愿者的最大壶腹长度和2 cm(对照组)；(B)患者或志愿者的最大壶腹/裂孔疝长度≥燕间缩小2 cm(缩小组)；和(C)患者的腹股沟无缩小的燕间腹股沟。对照组86%的受试者食道完全排空，无逆流者，腹股沟整复组66%，非还原腹股沟组32%(P<；0.05)。缩小疝组的排空障碍可归因于“晚期逆行血流”，即在排空过程中，钡从疝气中逆行喷出。非还原疝组的排空障碍可归因于LES松弛后立即发生的“早期逆行血流”。非还原疝组的酸液清除时间也长于对照组(P<；0.05)。我们的结论是，在非减少性裂孔疝患者中，胃食道连接功能严重受损，提示这一亚型裂孔疝参与了反流病的发病机制。
Concurrent videofluoroscopy and manometry were used to analyze esophageal emptying during barium swallows in 22 patients with axial hiatal hernias and in 14 volunteers. Subjects were divided into three groups: (a) volunteers with maximal phrenic ampullary length <2 cm (controls); (b) patients or volunteers with maximal ampullary/hiatal hernia length ≥2 cm that reduced between swallows (reducing-hernia group); and (c) patients with hernias that did not reduce between swallows. Complete esophageal emptying without retrograde flow was achieved in 86% of test swallows in the controls, 66% in the reducing-hernia group, and 32% in the nonreducinghernia group (P< 0.05). Impaired emptying in the reducing-hernia group was attributable to “late retrograde flow,” whereby barium squirted retrograde from the hernia during emptying. Impaired emptying in the nonreducing-hernia group was attributable to “early retrograde flow” that occurred immediately after LES relaxation. The nonreducinghernia group also had longer acid clearance times than the controls (P< 0.05). We conclude that gastroesophageal junction competence is severely impaired in patients with nonreducing hiatal hernias, suggesting a mechanism whereby this subgroup of hiatal hernia is involved in the pathogenesis of reflux disease.