Esophagogastric junction pressure topography after fundoplication
Esophagogastric junction pressure topography after fundoplication
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DOI：
10.1067/msy.2000.102045
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发表时间：
2000-02-01
期刊：
影响因子：
3.8
通讯作者：
Joehl, RJ
中科院分区：
文献类型：
--
作者：
Kahrilas, PJ;Lin, SZ;Joehl, RJ
目标。本研究将腹腔镜尼森胃底折叠术后的压力地形图与正常受试者以及食管裂孔疝和反流病患者的压力地形图进行了比较。方法。研究人员对 7 名接受胃底折叠术的患者、7 名正常受试者和 7 名食管裂孔疝患者进行了研究。用金属夹标记鳞柱交界处和食管胃交界处（EGJ）的胃内缘。相对于疝气绘制 EGJ 压力的轴向和径向特征，并在并行透视和测压期间进行剪裁。还分析了对吸气和腹部压缩的反应。结果，胃底折叠术通过恢复 EGJ 压力的裂孔成分和延长膈下成分来改变 EGJ。胃底折叠术后最大ECJ压力主要取决于食管裂孔管的外在作用，压迫食管； EGJ 的最终长度反映了胃底包裹的长度。胃底折叠术后 ECJ 的完整性独立于食管下括约肌本身。结论。胃底折叠术通过减少食管裂孔疝、收紧食管裂孔口并构建可变长度的膈下包裹来改变食管胃结合部的压力地形。每种效果取决于手术的不同技术方面，并且最终压力分布可能存在很大的变化。
Objectives. This study compared the pressure topography after laparoscopic Nissen fundoplication to that of normal subjects and patients with hiatal hernia and reflux disease.Methods. Seven patients with fundoplication, 7 normal subjects and 7 patients with hiatal hernia, were studied. The squamocolumnar junction and intragastric margin of the esophagogastric junction (EGJ) were marked with metal clips. Axial and radial characteristics of EGJ pressure were mapped relative to the hernia and clipped during concurrent fluoroscopy and manometry. Responses to inspiration and abdominal compression were also analyzed.Results, Fundoplication modifies the EGJ by restoration of the hiatal component of EGJ pressure and elongation of the subdiaphragmatic component. Maximal ECJ pressure after fundoplication is mainly dependent on the extrinsic effect of the hiatal canal that compresses the esophagus; the resultant length of the EGJ reflects the length of the fundic wrap. Integrity of the ECJ after fundoplication is independent of the intrinsic lower esophageal sphincter itself.Conclusions. Fundoplication alters the pressure topography of the EGJ by reducing the hiatal hernia tightening the hiatal orifice, and constructing a subdiaphragmatic wrap of variable length. Each effect depends on different technical aspects of the surgery with the potential of substantial variability in the,resultant pressure topography.