先天性膈疝术后食管功能及胃食管反流的临床观察

目的 了解先天性膈疝修补术后预后及术后食管功能和胃食管反流情况。方法 对46例先天性膈疝修补术后进行随访，13例进行了24h食管双极pH及24h动态压力测定，了解胃食管功能。结果 13例进行了24h食管pH及压力测定的膈疝修补术后患儿中，7例有胃食管反流，其中3例术中应用补片，4例术前显示胃疝入胸腔。结论 先天性膈疝修补术后可出现胃食管反流，24h测压及pH测定表现为食管蠕动功能明显减弱，这种食管下端蠕动功能减弱与膈疝修补术后出现胃食管连接解剖异常及膈肌发育不良可能相关。     

胆总管囊肿切除不同胆道重建术的远期疗效评价

目的分析和评价先天性胆总管囊肿切除后采用不同胆道重建手术方式的远期治疗效果。方法对1985-2000年所行121例胆总管囊肿切除、胆道重建手术治疗的患儿资料进行总结和长期随访观察，胆道重建手术包括单纯肝管空肠Roux-Y吻合27例、肝管十二指肠吻合黏膜乳头成形24例、回盲部肠段间置14例和肝管空肠Roux-Y吻合加曾氏防反流瓣56例四种术式。结果91例获得远期随访，平均时间11．7g。2例发生恶变，出现反复发作胆管炎13例(单纯吻合组7例、黏膜乳头成形组5例和加防反流瓣组1例)、吻合口狭窄8例和肝门胆管结石5例，11例再手术后症状消失。结论根治切除囊肿是治疗本病的基础，肝门大口肝管空肠Roux-Y吻合加抗反流瓣术是胆道重建手术可选择的最佳术式。     

肥厚性幽门狭窄手术前后胃食管pH动态改变

目的：采用24h pH动态监测技术观察肥厚性幽门狭窄患儿手术前后胃食管pH变化规律。方法：对28例肥厚性幽门狭窄患儿及21例正常儿行胃食管24h pH动态监测。结果：患儿组术前酸性胃食管反流指标较对照组明显增高，占57．1％，术后3，7d复检时，酸性反流指标明显降低，十二指肠胃反流指标增高，64．2％，术后显示十二指肠胃反流和混合性胃食管反流，术后1个月复检时胃食管反流指标明显降低。结论：肥厚性幽门狭窄术前以酸性胃食管反流为主，术后则以十二指肠胃反流和混合性反流为主，随着术后幽门管组织结构和功能的恢复，反流可逐渐改善。     

经腹腔镜行先天性胆总管囊肿切除肝管空肠Roux-Y吻合术的探讨

目的 探讨经腹腔镜行先天性胆总管囊肿切除，肝管空肠Roux-Y吻合术的可行性。方法 先天性胆总管囊肿5例，在腹腔镜监视下行胆囊穿刺胆道造影术，显示肝胆管和胰管病变，用电切或电凝切除胆总管囊肿。经脐部切口提出空肠，于腹壁外行空肠Roux-Y吻合，用5-0可吸收缝线，在腹腔镜监视下，将肝管与空肠端侧吻合。结果 本组5例患儿手术全部成功，手术时问平均为5．1h，(4．5h～6h)出血量20m1～50ml，吻合口直径1．0cm～1．5cm，平均住院时间6．5d，术后随访1个月～4个月，无肠粘连梗阻和吻合口狭窄发生。患儿肝功能各项指标正常。结论 经腹腔镜行先天性胆总管囊肿切除，肝管空肠吻合术是一种安全可靠的方法，具有创伤小，视野清楚，分离缝合准确、术后恢复快等优点。     

45例腹腔镜辅助胆总管囊肿根治术

目的本研究对腹腔镜先天性胆总管囊肿切除，肝管空肠Roux-Y吻合术进行探讨。方法从2001年6月至2003年9月，共收治先天性胆总管囊肿患儿45例，年龄2个月到12岩。其中42例为囊肿型，平均囊肿直径3.8cm（2-18cm）；其余3例为梭形，直径分别为1．5、2．0和2．2cm。本组45例患儿均经腹腔镜行先天性胆总管囊肿切除，肝管空肠Roux-Y吻合术。结果本组45例患儿手术全部成功，手术时间平均为4.3h（3．5～7．6h），术中出血量约5～10ml。本组8例患儿合并肝管狭窄，术中同时行腹腔镜胆总管囊肿切除及肝管成形；6例患儿合并共同管内蛋白栓，术中通过腹腔镜导入肠道或插管冲洗清除。其中1例患儿于术后第1d发生胆漏，术后第26d时自愈；其余44例患儿术后恢复顺利，住院时间3～6d。术后随访3～30个月，无肠粘连梗阻和吻合口狭窄等术后并发症发生。结论经腹腔镜先天性胆总管囊肿切除，肝管空肠吻合术是一种安全可靠的方法，术中胆道造影全面了解胆道的结构，清晰的肝门暴露，准确的囊肿分离和熟练的缝合技术是手术成功的关键。     

24小时食管pH值监测及空腹胃pH值测定在高危新生儿胃肠功能障碍诊断中的应用

目的 通过监测新生儿24 h食管pH值及测定胃pH值,研究其在新生儿胃肠功能障碍早期诊断中的价值.方法 对20例发生胃肠功能障碍的新生儿(A组)与20例未发生胃肠功能障碍的高危新生儿(B组)进行24h食管pH值监测及胃pH值测定,并对结果进行统计学分析.结果 A组患儿的胃pH值为2.22±0.30,B组为2.64±0.28,两组比胶差异有统计学意义(t=4.045,P＜0.01);根据Boix-Ochoa标准,A组发生病理性胃食管反流14例,B组7例;根据酸反流指数＞4.0％为病理性胃食管反流诊断标准,A组发生病理性胃食管反流12例,B组5例.两组24 h食管pH值差异有统计学意义(x2 =4.91,P＜0.05).结论 对高危儿进行24h食管pH值监测及胃pH值测定,有助于及时判断新生儿的胃肠功能状态,对新生儿胃肠功能障碍的早期诊断具有临床价值.     

改良囊肿切除肝管空肠Roux-Y吻合术治疗先天性胆总管囊肿

目的：探讨治疗小儿先天性胆总管囊肿的手术方法。方法：本组30例,男12例,女18例,年龄14月至6岁,均采用改良囊肿切除、肝管空肠Roux-Y吻合术治疗。结果：30例均痊愈出院。随访3个月至5年,未出现腹痛、黄疸、发热等症状。经B超检查,未见胆管狭窄;6例消化道钡餐检查未见钡剂返流入肝管空肠吻合口。结论：改良囊肿切除、肝管空肠Roux-Y吻合术是治疗先天性胆总管囊肿的较好方法。     

30例巨大胆总管囊肿的临床诊断和治疗分析

目的 探讨巨大胆总管囊肿在诊断及治疗方面的经验. 方法 对30例巨大胆总管囊肿患儿的临床资料进行回顾性分析.结果 本组30例患儿中,有4例手术后出血,1例术后出现胆瘘,经保守治疗成功.其余患儿住院期间恢复顺利.随访6个月至8年,患儿均无腹痛、发热、黄疸等异常情况. 结论 胆总管囊肿切除＋肝总管空肠Roux-Y吻合术治疗巨大先天性胆总管囊肿效果良好.     

24 h食管pH监测在婴儿难治性肺炎中的临床应用研究

目的探讨24h食管pH监测在婴儿难治性肺炎中的临床应用及其意义。方法对57例难治性肺炎患儿进行24h食管pH监测,监测指标包括食管pH〈4.0的次数、反流时间≥5min的次数、最长反流时间、卧位pH值〈4的时间占总监测时间的百分比和Biox-Ochoa评分。结果57例中存在胃食管反流（GER）28例（占49.1%）;有呕吐与无呕吐症状患儿各项反流指标比较差异有统计学意义;伴有胃食管反流患儿经促动力剂治疗者,肺部罗音消失时间和咳嗽持续时间均较未用促动力剂治疗者短,差异有统计学意义（P〈0.05）。结论难治性肺炎患儿经正规抗炎治疗效果不佳者,应考虑是否合并胃食管反流,进行24h食管pH监测,以确定病因并指导治疗。     

先天性胆总管囊肿28例治疗体会

目的 探讨先天性胆总管囊肿的治疗体会。方法 回顾分析1990年到2001年28例先天性胆总管囊肿的治疗,其中男10例,女18例,囊肿十二指肠吻合6例,囊肿外引流3例,囊肿切除肝管空肠Roux—Y吻合15例,囊肿切除空肠间置肝管十二指肠吻合4例。 结果 先天性胆总管囊肿应行根治性囊肿切除,肝总管空肠Roux—Y型吻合术或肝管空肠问置式并加人工抗反流措施。 结论 先天性胆总管囊肿应行根治性切除,并需注意近、远期并发症的防治。     

Association of gastroesophageal reflux disease in young children with persistent respiratory symptoms

Forty children aged between 3 months and 3 years (median age 14 months) with persistent respiratory symptoms beyond 4 weeks or recurrence of respiratory symptoms were investigated for gastroesophageal reflux (GER). Diagnostic tests included upper gastrointestinal endoscopy, oesophageal biopsy, gastroesophageal scintiscan and 24 h ambulatory oesophageal pH monitoring. GER was detected in 14 (35 per cent) of these patients; which included 38 per cent of the enrolled cases of recurrent bronchopneumonia, 40 per cent cases of reactive airway disease, and 22 per cent cases of persistent cough. Amongst the cases detected to have GER, the age of onset of respiratory symptoms was less than 1 year in 86 per cent of cases (p < 0.01), nocturnal symptoms of cough and wheeze were reported in 78 per cent (p < 0.05), and 86 per cent cases did not present with typical gastrointestinal symptoms (p < 0.01). Family history of asthma was absent in all cases of GER-related reactive airway disease (p < 0.01). Cases detected to have GER were followed for 3-6 months after starting anti-reflux therapy. A significant (p < 0.01) decrease was noticed in the number of further episodes in children with GER-related recurrent bronchopneumonia and reactive airway disease after starting anti-reflux therapy. Improvement was also noticed in nocturnal symptoms and nutritional status after anti-reflux therapy was started. Our results suggest that GER may be one of the possible contributing factors in any child with recurrent and persistent respiratory complaints. Early diagnosis and anti-reflux therapy in cases with GER-related respiratory complaints can result in significant improvement in symptoms.     

Prolonged esophageal pH monitoring in the evaluation of gastroesophageal reflux in children with chronic tubotympanal disorders

BACKGROUND: Children with ear, nose and throat disorders are believed to have a high incidence of pathologic gastroesophageal reflux (GER). This study was designed to establish the frequency and ratio of pathologic GER in the development of chronic tubotympanal disorders. METHODS: Twenty-seven children with chronic tubotympanal disorders (mean age, 2 to 13 years; average age, 6.8 years) underwent 24-hour continuous pH monitoring. Fourteen of the examined patients had secretory otitis, whereas 13 patients had recurrent otitis. From each 24-hour pH monitoring, 12-hour daytime and nighttime periods were selected. Eleven patients were tested using simultaneous dual pH monitoring (distal and proximal pH monitoring). RESULTS: Fifteen (55.6%) of 27 patients had pathologic GER. The authors did not find a relation between pathologic GER and different types of ear disorders. Daytime pH monitoring yielded significantly more episodes of reflux than did nighttime monitoring. The reflux index was substantially higher during the day. In the current study, distal pH monitoring showed that 6 of 11 patients had pathologic GER, whereas proximal pH monitoring showed that only only 3 of 11 patients had pathologic GER. CONCLUSIONS: The authors recommend that a pH study be performed in children with chronic tubotympanal disorders when standard treatment is ineffective. The method of choice for the diagnosis of pathologic GER in patients with chronic tubotympanal disorders should be pH monitoring of the esophagus and throat.     

新生儿胃食管返流的24小时食管内pH监测

目的探讨新生儿胃食管返流食管内pH的变化及其临床意义。方法疑诊为新生儿胃食管返流36例，以无症状新生儿15例作对照。用便携式24小时食管、胃pH自动记录仪（Digitrapper型）在常态下作24小时食管内pH监测。食管pH降至4以下持续15秒钟以上定义为一次返流。结果疑诊为新生儿胃食管近流的36例中14例Boix－Ochoa评分＞11．99为病理性返流，22例为生理性返流。15例对照组中2例为生理性返流，13例为正常。结论24小时新生儿食管内pH监测为早期诊断新生儿胃食管返流提供客观依据。     

24Сʱʳ�ܶ�̬pH-�迹���ϼ������С��θʳ�ܷ����Կ��Ե��ٴ�����

??Abstract??Objective To investigate the characteristics of gastroesophageal reflux disease ??GERD?? with chronic cough by 24-hour ambulatory esophageal impedance-pH monitoring in children. Methods From February 2012 to July 2013?? 40 cases of inpatients and outpatients in Nanjing Children′s Hospital Affiliated to Nanjing Medical University?? who were suspected with gastroesophageal reflux cough ??RERC????were recruited??all these cases underwent 24-hour ambulatory esophageal impedance-pH monitoring. Results Among the 40 children with chronic cough?? 23 patients were diagnosed with GERD refering to pH monitoring??34 children were diagnosed with GERD by 24-hour ambulatory esophageal impedance-pH monitoring. Esophageal acid reflux were significantly higher in the upright than supine position ??P??0.05????and the characteristics of GERD with chronic cough was mainly weak acidic reflux and acid reflux in the upright ??P??0.05????the mixed reflux was the highest frequency in the upright ??P??0.05??. There was no difference between in the upright and supine position about the bolus clearance time??proximal reflux in the supine position was the main way in the total reflux ??P??0.05??. The total reflux and SI demonstrated positive correlation??r = 0.818?? P??0.05??. Conclusion Acid reflux?? weak acid reflux and non-acid reflux can be detected by 24-hour ambulatory esophageal impedance-pH monitoring. The 24-hour ambulatory esophageal impedance-pH monitoring can make more accurate diagnosis of GERD in chronic cough children??and it may have a good prospect for clinical application.     

24小时食管动态pH-阻抗联合监测评估小儿胃食管反流性咳嗽的临床特征

目的 探讨24 h食管动态pH-阻抗联合监测对以慢性咳嗽为主要表现的胃食管反流病（GERD）患儿的临床表现及反流特征的评估价值。方法 对2012年2月至2013年7月40例南京医科大学附属南京儿童医院门诊及住院的可疑胃食管反流性咳嗽（RERC）患儿,利用24 h食管pH-阻抗联合监测GERD患者的各项指标。结果 40例慢性咳嗽患儿中,单纯用24 h食管pH监测符合GERD的患儿有23例（57.5%）,利用24 h食管动态pH-阻抗联合监测符合GERD的患儿有34例（85.0%）,明显高于单纯用24 h食管pH监测的结果。且在小儿慢性咳嗽中主要是在直立时弱酸反流和酸反流为主（P＜0.05）,同时发生频率最高的在直立状态下的混合反流（P＜0.05）,而食团清除时间在直立与仰卧时差异无统计学意义（P＞0.05）,近端反流是以仰卧位为主（P＜0.05）。总反流次数与症状指数（SI）呈正相关（r = 0.818,P＜0.05）。结论 利用24 h食管动态pH-阻抗联合监测技术可以检出酸反流、弱酸反流和非酸反流,使GERD的诊断更精确,对以慢性咳嗽为主要表现的GERD有着重要的诊断价值,具有较好的临床应用前景。     

A new ambulatory system for extended esophageal pH monitoring

A new 24-h ambulatory esophageal pH monitoring system (AMBI 24) was evaluated in 72 pediatric patients with suspected gastroesophageal reflux (GER). Forty-seven of these patients were monitored at home and the other 25 in our hospital. This system was employed without complication in infants and a full range of pediatric patients, as well as in older children with severe psychomotor delay. The data obtained were consistent with those reported utilizing standard monitoring equipment, and the results served as the basis for subsequent medical management. The results of this study, therefore, suggest that this method of esophageal pH monitoring is a safe and effective means of evaluating GER while allowing for patient mobility.     

Influence of percutaneous endoscopic gastrostomy on gastroesophageal reflux: a prospective study in 68 children

BACKGROUND: Among other complications, the development of or an increase of gastroesophageal reflux (GER) is considered to be associated with percutaneous endoscopic gastrostomy (PEG). However, the few studies performed to date show controversial results. METHODS: Continuous 24-hour pH monitoring was performed prospectively in 68 patients before and at least 3 days after percutaneous endoscopic gastrostomy placement. None of the patients had been treated for gastroesophageal reflux. RESULTS: The percentage of patients with abnormal test results did not differ significantly before and after PEG insertion (22.1% versus 25%). Nor did the median reflux index change significantly before and after gastrostomy for the whole group of patients (2.6% versus 3.4%). The median reflux index increased significantly (from 1.8 to 5.4) only in patients who underwent PEG implantation in the antrum (n = 9). Clinical signs of GER correlated poorly with the results of pH monitoring. CONCLUSIONS: Data in this study strongly suggest that, in general, percutaneous endoscopic gastrostomy does not provoke gastroesophageal reflux. Results also indicate that placement in the antrum may be unfavorable.     

联合食管多通道腔内阻抗-pH监测婴幼儿胃食管反流病

目的 评价24 h 联合食管多通道腔内阻抗-pH 监测（24 h MⅡ-pH）在婴幼儿胃食管反流病中的诊断价值,分析伴有反复肺炎的胃食管反流婴幼儿的反流特点。方法 疑诊胃食道反流的反复肺炎婴幼儿17 例,行24 h MⅡ-pH 监测,分析反流物性质和特点。结果 17 例患儿中阳性11 例（65%）,共监测到853 次反流周期,其中65.3% 为酸反流,以餐后2 h 以内发生为主（69.5%）;71.6%为混合反流;反流发生的体位从多至少依次为直立位、仰卧位、侧卧位和俯卧位;反流物的高度以远端反流为主。根据Biox-ochoa 评分,重度反流的患儿占73%（8/11）。结论 联合食管MⅡ-pH 监测可分析反流物性质,增加胃食道反流病的检出率。