您的位置：山东大学 -> 科技期刊社 -> 《山东大学学报（医学版）》

山东大学学报（医学版） ›› 2015, Vol. 53 ›› Issue (6): 58-62.doi: 10.6040/j.issn.1671-7554.0.2014.583

• 临床医学 • 上一篇    下一篇

非梗阻性吞咽困难的动力特点及病因分析

杜全林1, 褚传莲2, 李延青3, 陈飞雪3, 田宝苓3   

  1. 1. 潍坊医学院临床学院消化内科, 山东 潍坊 261053;
    2. 山东大学附属济南市中心医院消化内科, 山东 济南 250013;
    3. 山东大学齐鲁医院消化内科, 山东 济南 250012
  • 收稿日期:2014-09-06 修回日期:2015-03-19 发布日期:2015-06-10
  • 通讯作者: 褚传莲。 E-mail:chuchucl@163.com;李延青。 E-mail:liyanqing@sdu.edu.cn E-mail:chuchucl@163.com;liyanqing@sdu.edu.cn
  • 基金资助:
    山东省科技发展计划(2013G0021804)

Analysis of esophageal motility characteristics and causes of non-obstructive dysphagia

DU Quanlin1, CHU Chuanlian2, LI Yanqing3, CHEN Feixue3, TIAN Baoling3   

  1. 1. Department of Gastroenterology, Clinical Institue of Weifang Medical University, Weifang 261053, Shandong, China;
    2. Department of Gastroenterology, Jinan Central Hospital of Shandong University, Jinan 250013, Shandong, China;
    3. Department of Gastroenterology, Qilu Hospital of Shandong University, Jinan 250012, Shandong, China
  • Received:2014-09-06 Revised:2015-03-19 Published:2015-06-10

PDF (PC)

112

摘要： 目的 通过高分辨率食管测压(HRM)探讨非梗阻性吞咽困难(NOD)的常见病因及其动力特点。方法 选取2011年1月到2014年5月在山东大学齐鲁医院以吞咽困难为主诉就诊并行HRM检查的患者作为研究对象进行回顾性分析。通过询问病史、内镜或上消化道钡透检查确定NOD患者,应用HRM分析NOD患者的上食管括约肌压力(UESP),下食管括约肌压力(LESP),下食管括约肌长度(LESL),残余压、整合松弛压(IRP),远端收缩积分(DCI)等指标, 并分析内镜下表现。结果 在72例NOD患者中,贲门失弛缓症、功能性吞咽困难、胃食管反流病(GERD)患者分别占52.8%(38)、33.3%(24)、13.9%(10)。贲门失弛缓症患者蠕动缺失78.9%、同步收缩81.6%、LES松弛不完全97.4%。在24 例功能性吞咽困难中,下食管括约肌(LES)松弛不完全或不松弛者为16例(66.7%),松弛完全者为 8 例(33.3%),上食管括约肌(UES)松弛不完全者为7例(29.2%);食管体部蠕动正常8 例(33.3%),蠕动缺失4例(16.7%),低幅蠕动8例(33.3%),远端食管痉挛2例(8.3%),其他测压异常2例(8.3%)。贲门失弛缓症患者LESP、残余压、IRP中位数(四分位数间距)分别为17(8,28)、11(6,19)、9(4,18)均高于功能性吞咽困难组9(5,14)、4(0,7)、2(0,6),(P均<0.05),而UESP、LESL、DCI两组之间差异无统计学意义。贲门失弛缓症组残余压、IRP均高于GERD组[11(6,19) vs 4(3,7), P=0.005, 9(4,18) vs 3(1,5), P=0.007)],而功能性吞咽困难和GERD组之间各参数无统计学差异。贲门失弛缓症内镜下表现为食管不同程度的扩张,可见食物潴留、贲门口狭窄。功能性吞咽困难组内镜下食管无特异性变化,内镜下GERD组中3例表现为糜烂性食管炎,7例未见明显异常。结论 NOD患者常见原因以贲门失弛缓症为主,其次为功能性吞咽困难。NOD患者的发病机制是多样的,食管体部蠕动异常、LES松弛不完全是其重要原因。HRM是诊断NOD的重要检查方法。

关键词: 测压法, 食管失弛缓症, 吞咽困难, 内镜, 食管动力障碍

Abstract: Objective To analyze the causes and esophageal motility characteristics of patients with non-obstructive dysphagia (NOD) by esophageal high resolution manometry (HRM). Methods Esophageal HRM data of patients with dysphagia treated during Jan. 2011 and May 2014 at Qilu Hospital of Shandong University were collected. Patients suffering from obstructive dysphagia were excluded through history inquiry, endoscopic images and barium examination. Parameters including upper esophageal sphincter pressure (UESP), lower esophageal sphincter pressure (LESP), loweresophageal sphincter length (LESL), residual pressure, integrated relaxation pressure (IRP), distal contractile integral (DCI) and endoscopic results were analyzed. Results Among the 72 patients with NOD, the percentage of achalasia, functional dysphagia and gastroesophageal reflux disease (GERD) was 52.8% (38/72), 33.3% (24/72), 13.9% (10/720), respectively. Of the 38 patients with achalasia, the percentage of absent peristalsis, synchronous contraction, lower esophageal sphincter(LES) incomplete relaxation was 78.9%, 81.6% and 97.4%, respectively. Of the 24 patients with functional dysphagia, the cases of LES incomplete relaxation, upper esophageal sphincter(UES) incomplete relaxation, absent peristalsis, low amplitude peristalsis, distal and esophageal spasm was 16(66.7%), 7(29.2%), 4(16.7%), 8(33.3%) and 2(8.3%). The median (IQR) of LESP, residual pressure, IRP in achalasia patients were 17 (8, 28), 11 (6, 19), 9 (4, 18) respectively, which were higher than those of functional dysphagia group[9(5, 14), 4(0, 7), 2(0, 6), P<0.05]. No difference was found in UESP, LESL and DCI between the two groups. Residual pressure, IRP of patients with achalasia was higher than that of GERD group[11(6, 19) vs 4(3, 7), P=0.005, 9(4, 18) vs 3(1, 5), P=0.007]. There was no difference between functional dysphagia and GERD. Esophageal dilatation, food retention, and cardia stricture were the main endoscopic presentations of achalasia. Functional dysphagia group had no specific endoscopic change. In group of GERD, 3 cases showed erosive esophagitis and 7 cases had no obvious endoscopic abnormalities. Conclusions Achalasia is the most common cause of NOD, followed by functional dysphagia. The pathogenesis of NOD is diverse. Abnormal peristalsis and LES incomplete relaxation are the most two important factors of NOD. HRM is an important method for the diagnosis of NOD.

Key words: Dysphagia, Esophageal achalasia, Esophageal Disorder, Endoscopy, Manometry

中图分类号: 

  • R571
[1] 张莉莉, 赵威, 王邦茂. 非梗阻性吞咽困难高分辨率食管测压分析[J]. 中华消化杂志, 2013, 33(10): 664-668. ZHANG Lili, ZHAO Wei, WANG Bangmao. Analysis of non-obstructive dysphagia with esophageal high-resolution manometry[J]. Chinese Journal of Digestion, 2013, 33(10): 664-668.
[2] 张玲, 林寒, 朱泱蓓, 等. 应用高分辨率测压研究不同亚型贲门失弛缓症患者的食管动力学特点[J]. 中华消化杂志, 2013, 33(2): 84-87. ZHANG Ling, LIN Han, ZHU Yangbei, et al. Characteristics of esophageal motility of different types of achalasia patients by high resolution manometry[J]. Chinese Journal of Digestion, 2013, 33(2): 84-87.
[3] Bredenoord AJ, Fox M, Kahrilas PJ, et al. Chicago classification criteria of esophageal motility disorders defined in high resolution esophageal pressure topography[J]. Neurogastroenterol Motil, 2012, 24(Suppl 1): 57-65.
[4] 李真, 李延青. 2013 国际胃食管反流病诊断和管理指南解读[J]. 中国医学前沿杂志:电子版, 2013, 5(5): 57-63.
[5] 陈旻湖. 功能性胃肠病罗马Ⅲ标准解读: 功能性食管病[J]. 临床消化病杂志, 2006, 18(5): 260.
[6] Burgess NG, Wyeth JW. An audit of combined multichannel intraluminal impedance manometry in the assessment of dysphagia[J]. J Gastroenterol Hepatol, 2011, 26(3): 79-82.
[7] Jacob P, Kahrilas PJ, Vanagunas A. Peristaltic dysfunction associated with nonobstructive dysphagia in reflux disease[J]. Dig Dis Sci, 1990, 35(8): 939-942.
[8] Chen CL, Yi CH. Clinical correlates of dysphagia to oesophageal dysmotility: studies using combined manometry and impedance[J]. Neurogastroenterol Motil, 2008, 20(6): 611-617.
[9] 陈文妹, 向雪莲, 涂雷, 等. 固态和水灌注高分辨率测压系统检测食管功能一致性的研究[J]. 胃肠病学, 2013, 18(4): 206-210. CHEN Wenmei, XIANG Xuelian, TU Lei, et al. Consistency between solid-state and water-perfused high-resolution manometry in testing esophageal function[J]. Chinese Journal of Gastroenterology, 2013, 18(4): 206-210.
[10] 张艳丽, 方秀才, 柯美云. 精神心理因素与功能性食管病[J]. 胃肠病学, 2008, 13(2): 68-71. ZHANG Yanli, FANG Xiucai, KE Meiyun. Psychological profile and functional esophageal disorders[J]. Chinese Journal of Gastroenterology, 2008, 13(2): 68-71.
[11] Sugiura T, Iwakiri K, Kotoyori M, et al. Relationship between severity of reflux esophagitis according to the Los Angeles classification and esophageal motility[J]. J Gastroenterol, 2001, 36(4): 226-230.
[1] 冯子超,王济潍,李超,李卫国,陈腾,马翔宇,徐淑军,李新钢. 单纯神经内镜在桥小脑角区的手术应用[J]. 山东大学学报（医学版）, 2016, 54(10): 71-75.
[2] 侯传强,刘英果,刘运龙,周秀芬. i-scan内镜在上消化道癌筛查中的应用[J]. 山东大学学报（医学版）, 2016, 54(1): 42-44.
[3] 王济潍, 李超, 陈腾, 张文华, 李卫国, 马翔宇, 徐淑军, 李新钢. 单纯神经内镜下微血管减压术治疗原发性三叉神经痛[J]. 山东大学学报（医学版）, 2015, 53(4): 83-86.
[4] 王春来, 徐淑军, 王洪亮, 尚景瑞. 神经内镜下外伤性脑脊液鼻漏修补的临床研究[J]. 山东大学学报（医学版）, 2015, 53(3): 69-72.
[5] 周晓艳, 李铭, 郭婧, 左秀丽, 李延青. 黏液填充在消化道上皮微缺损及肠屏障功能中的作用[J]. 山东大学学报（医学版）, 2015, 53(12): 62-66,80.
[6] 徐然, 马翔宇, 李卫国, 李超, 张鑫, 徐淑军, 李新钢. 神经内镜下乙状窦后锁孔入路微血管减压术治疗面肌痉挛[J]. 山东大学学报（医学版）, 2015, 53(10): 55-57.
[7] 王小明, 陈明, 黄松, 段磊, 朱秀云. 内镜黏膜下挖除术加创面尼龙绳荷包缝合法在 胃窦异位胰腺治疗中的临床应用[J]. 山东大学学报（医学版）, 2014, 52(S2): 76-77.
[8] 王晗, 石莎, 陈飞雪, 李月月, 曹静, 左秀丽, 李延青. 共聚焦激光显微内镜在体评估NSAIDs相关胃病及其药物干预效果[J]. 山东大学学报（医学版）, 2014, 52(8): 6-13.
[9] 吴善彬，许洪伟，刘慧，李宾. 血管内血管旁联合注射硬化剂治疗食管静脉曲张出血[J]. 山东大学学报（医学版）, 2014, 52(6): 85-89.
[10] 刘风燕, 韩冰, 钟宁, 郑雪婷, 李文捷, 韩炜, 贾晓青, 李延青. 上消化道黏膜下病变套扎治疗的远期效果及其影响因素[J]. 山东大学学报（医学版）, 2014, 52(12): 78-82.
[11] 展如才, 王东海, 王新宇, 李新钢. 神经内镜经鼻手术简史及多层颅底重建技术现状[J]. 山东大学学报（医学版）, 2014, 52(11): 1-5.
[12] 冯珊珊,姜军梅,刘吉勇,杨崇美,张俊勇,张安忠,王冠华,许诺. 电子超声内镜在食管黏膜层及黏膜下病变诊疗中的作用[J]. 山东大学学报(医学版), 2012, 50(7): 97-.
[13] 张庆泉，宋西成，张华，王强，孙岩，陈秀梅，姜绍红. 内镜下影像导航技术在1250例鼻颅底手术中的应用[J]. 山东大学学报(医学版), 2012, 50(7): 114-116.
[14] 陆晓恒，郝洪升，孙莉娟，李文捷，宋璇，卢雪峰. 超声内镜对十二指肠囊肿和脂肪瘤的鉴别诊断价值[J]. 山东大学学报(医学版), 2012, 50(3): 100-.
[15] 李文捷，孙莉娟，郝洪升，钟宁，卢雪峰，李延青. 超声内镜对胃异位胰腺的诊治价值[J]. 山东大学学报(医学版), 2011, 49(9): 91-.
Viewed
Full text


Abstract

Cited
  Shared   
  Discussed   
No Suggested Reading articles found!
版权所有 © 2018 《山东大学学报(医学版)》编辑部　
地址:山东大学科技期刊社（济南市历城区山大南路27号山东大学中心校区明德楼B座721室） 电话: 0531-88366918 E-mail: xbyxb@sdu.edu.cn
本系统由北京玛格泰克科技发展有限公司设计开发