Laimer纤维在贲门失弛缓症患者中的表现情况

目的探讨Laimer纤维在贲门失弛缓症（AC）患者中的发生情况及其形态学特征。方法收集107例行经口内镜下肌切开术（POEM）治疗的AC患者的病例资料，重新筛查每例患者的POEM手术视频，根据患者性别、年龄段、AC内镜下Ling分型及Laimer纤维所在部位分类统计Laimer纤维发现率并行对比分析。结果44例存在Laimer纤维，发现率为41．12％（44／107）。不同性别、不同年龄段AC患者中发现率比较差异均无统计学意义（P〉0．05）；LingIIb型发现率最高（46．15％，12／26），其次为I型（45．83％，22／48），Ⅲ型无发现，Ling各型发现率比较差异无统计学意义（X2=2．042，P=0．564）；Laimer纤维均位于食管下段括约肌中，食管右侧壁发现率最高（36．45％，39／107），其次为食管左侧壁（3．74％，4／107），食管前壁无发现，食管各部位发现率比较差异有统计学意义（X2=107．468，P=0．000），但是食管不同部位黏膜隧道开口者发现率比较差异无统计学意义（X2=7．055，P=0．070）。结论Laimer纤维较为普遍存在于AC患者食管下段括约肌中，且多见于食管右侧壁，但与AC的发病关系以及对食管下段括约肌功能的影响尚需进一步研究验证。

Incidence and morphology of Laimer fiber in achalasia patients

Objective To investigate the incidence, location and morphological features of Laimer fibers between mucosal layer and inner circular muscularispropria in patients with achalasia. Methods Data of 107 patients with achalasia who underwent POEM between May 2010 and June 2013 were collected. Endo- scopic video was reviewed to determine the incidence of Laimer fibers and the corresponding images were an- alyzed according to gender, age, Ling typing and location of Laimer fibers. Results Laimer fibers were found in lower esophageal sphincter of 44 patients （41.12%）. There were no significant differences in the inci- dences of Laimer fiber among groups with different age or gender （ P 〉 0. 05 ）. The incidence in Ling type II b was 46. 15% （ 12/26）, and 45. 83% （22/48） in Ling type I , 0 in Ling type Ill. There was no signifi- cant difference among the groups of Ling type （X2 = 2. 042, P = 0. 564 ）. All Laimer fibers were found in lower esophageal sphincter and the majority of which were in right wall （36. 45% ,39/107）, followed by left wall （3.74% ,4/107） and none was found in anterior wall （X2 = 107. 468, P = 0. 000）. Conclusion Laimer fibers generally exists in lower esophageal sphincter and most of which are discovered on right wall of the esophagus. Further study is needed to explore its role in development and treatment of achalasia.