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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

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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
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