不同类型功能性便秘患者肛门直肠动力和感觉功能的研究

目的:通过对不同类型功能性便秘(FC)患者肛门直肠动力和感觉功能的研究,比较不同类型FC患者病理生理机制上的异同.方法:根据结肠转运时间(CTT)和传输指数(TI)对FC患者进行分型,分为传输时间正常型(NTC)、慢传输型(STC)、出口梗阻型(OOC)和混合型(MC);用肛门直肠测压的方法测定不同类型FC患者的肛门直肠动力及感觉功能,同时选择健康人作对照组.结果:与健康对照组相比,FC患者肛管静息压降低,排便感觉阈值和最大耐受容量均增高(P<0.01);各型FC患者肛管静息压均降低(P<0.01);NTC组和OOC组排便感觉阈值和最大耐受容量增高(P<0.01);STC组引起直肠肛门抑制反射的最低容量(MRV)降低,初始感觉阈值降低、排便感觉阈值增高(P<0.05);各组间肛管静息压、缩榨压、排便感觉阈值比较均未见明显异常.结论:肛门直肠动力和感觉功能异常,是FC患者发病的一个重要的病理生理机制.NTC患者和OOC患者在动力和感觉功能上表现出一定的共性,推断其病理生理机制可能存在一定的联系.STC患者的发病是多因素造成的动力紊乱.     

Reproducibility of antroduodenal motility during prolonged ambulatory recording

Ambulatory recording of antroduodenal manometry is a novel technique with several advantages over standard stationary manometry recording. Although the feasibility of this technique in clinical practice has been demonstrated, reproducibility of antroduodenal motility recorded by means of ambulatory manometry has not been investigated. To test whether antroduodenal motility recorded by ambulatory manometry is reproducible, we performed two 24-h ambulatory antroduodenal manometry recordings in 18 healthy subjects according to an identical protocol with a 1-week interval. Motility was recorded with a five-channel solid-state catheter. Postprandial motility was recorded after consumption of two test meals and interdigestive motility was recorded nocturnally. Postprandial antroduodenal motor characteristics were identical between the separate recordings. The number and duration of nocturnal cycles of the interdigestive migrating motor complex were also in the same range. Phase III characteristics in general were not different between the two recordings. Only minor alterations were observed in the duration of phase III motor fronts with duodenal onset and in the number of interdigestive cycles concluded by duodenal onset phase III. Parameters obtained by qualitative analysis were comparable between the two recordings. The antroduodenal motility pattern, when measured by ambulatory recording with solid state catheters under standardized conditions, is very reproducible.     

A study on motility of sphincter of Oddi in postcholecystectomy syndrome

Endoscop c manometry of sphincter of Oddi(SO)and serumlevels of gastrin,glucagon,and somatostatin were measured in patients withpostcholecystectomy syndrome(n=12),asymptomatic cholecystectomised pa-tients(n=6),and controlled subjects(n=14).Pentagastrin-stimulated gastricacid secretion test was also performed in part of patients who had symptoms orno symptoms after gallbladder resection.The results showed that the patientsof symptomatic group had hypertonic dyskinesia of SO as shown by deep andwide waves superimposed on high basal pressure plateau of SO.The symptoma-tic group also had a higher serum level of gastrin and a greater BAO than tho-se of other two groups.No difference of serum levels of glucagon and soma-tostatin was found among these three groups.The hypertonic dyskinesia of SOand hypergastrinemia are considered as possibly important factors in the patho-genesis of postcholecystectomy syndrome.     

Papillary dilation vs sphincterotomy in endoscopic removal of bile duct stones a randomized trial with manometric function

To circumvent the long-term effects of papillary ablation for extracting common bile duct stones (<12 mm in diameter) in endoscopic sphincterotomy (EST), endoscopic papillary dilation (EPD) was attempted in 20 patients. To evaluate papillary function before and after the procedures, manometry of the sphincter of Oddi was carried out in 13 with EPD and 10 of 20 patients with EST. Extraction of all stones was successful (100%) in both groups at an equal rate. Repeated numbers of procedures were common in both groups. However, the mean duration of the procedure was high in EPD compared to EST (63 min vs 42 min,P<NS). Adjunctive therapies like mechanical lithotripsy (ML), nasobiliary drainage, and choledochoscopy were included in EPD, while EST required a basket catheter and ML. There was no significant difference on manometry before and after the procedures (P=NS), although papillary function was found to have decreased after the EPD. In contrast, all patients in the EST group lost papillary function after the procedure. Thirty-day morbidity and mortality rate were absent in both groups. Immediate and 2.5-year follow up complications were uncommon in both groups. As a simple method, EPD may be an effective and safe alternative to EST in the management of patients with bile duct stones who require maintenance of papillary function.     

Minimal access surgery for gastroesophageal reflux: laparoscopic placement of the Angelchik prosthesis in pigs

Summary Conventional surgery for gastroesophageal reflux is effective but requires laparotomy. Minimal access surgery for gastroesophageal reflux could provide a decrease in morbidity. The Angelchik antireflux prosthesis is an alternative to fundoplication for the treatment of this ailment. We evaluated the results of laparoscopic placement of the Angelchik prosthesis in 10 pigs. The duration of the procedure averaged 44 min. The mean lower esophageal sphincter pressure increased from 12.2 ±2.8 mmHg at baseline to 45.2±7.8 (P <0.05), 32.1 ±3.9 (P<0.05), and 25.1 ±6.5 mmHg (P >0.05) as measured immediately postoperatively, at 1 week, and at 3 weeks, respectively, following placement of the prosthesis. There was no instance of prosthetic migration or esophageal perforation. One postoperative death due to distention and perforation of the colon occurred. Two animals developed distal esophageal impaction of food. We conclude that the antireflux prosthesis can be safely and effectively placed using laparoscopic methods in a porcine model. Further development of this technique is warranted.     

The effect of intravenous diazepam on esophageal motility in normal subjects

Controversy exists over whether diazepam can be used for sedation during esophageal manometry studies without affecting the results. To evaluate the effect of diazepam, 20 healthy asymptomatic volunteers were studied using a standard manometry protocol employing an Arndorfer capillary infusion system. Following a baseline manometry, each subject received 0.1 mg/kg diazepam intravenously over 1 min and underwent repeat manometry 5 min after completion of the injection. All manometry recordings were coded and read blindly. The amplitude of the lower esophageal sphincter was significantly reduced by diazepam from 26.2±10.9 and 30.0±10.9 mm Hg to 18.8±7.6 and 24.5±9.7 mm Hg by rapid and station pull-through methods, respectively (P<0.01 all both methods). Esophageal contraction wave duration was significantly increased following diazepam at 3, 8, and 13 cm above the lower esophageal sphincter (P<0.01 all levels). There was a trend toward increased contraction wave amplitude following diazepam administration in the lower three fourths of the esophagus. On the basis of these results, we conclude that diazepam sedation may produce misleading results when used during esophageal manometric testing. It is recommended that diazepam not be used in manometric studies of normal subjects or patients with reflux esophagitis and that manometric findings in patients with hypertensive or spastic disorders be interpreted with caution if diazepam is given as a premedication.     

食管测压及24小时pH监测结果分析——附60例报告

目的：通过食管测压及ｐＨ监测，观察食管在静息和吞咽后各部分的压力变化，探讨食管测压及ｐＨ监测之临床意义。方法：应用多导胃肠功能测定仪及便携式ｐＨ监测记录仪，对６０例患者进行了食管压力测定及４５例食管动态２４小时ｐＨ监测。结果：２５例患者上、下食管括约肌位置、松驰率、食管蠕动收缩的波幅、时限等，数据与国内报道正常值接近，下食管括约肌静息压（ＬＥＳＰ）及上食管括约肌静息压（ＵＥＳＰ）接近或略低于国内报道正常值。２３例２４ｈｐＨ监测提示有酸反流之患者中，１６例ＬＥＳＰ明显低于正常。结论：有助于贲门失驰缓之早期诊断；ＬＥＳＰ与反流有明显关系。     

内镜直视下幽门压力波的检测

报告了纤维胃镜直视下幽门压力波的检测方法,初步探讨了幽门压力波的特点,分类及其临床意义。该方法简便易行,准确客观,为临床诊断胃功能障碍和观察中药、针灸及其他治疗方法对胃运动功能的影响提供了一种新的研究手段。     

Ileal manometry in children following ileostomies and pull-through operations

Our aim was to analyse the patterns of ileal contractions in children. We reviewed the charts of 23 children who had ileal manometry studies (16 males), mean age 7 years (range 2 months to 17 years). We positioned the manometry catheters with 4-8 recording sites, 5 or 15 cm apart, through ileostomies fashioned for clinically indicated reasons. We studied six additional children with persistent faecal soiling following endorectal pull through for Hirschsprung's disease; the catheters were positioned through the anus and colon into the ileum. We recorded phasic and tonic intermittent contractions in all the subjects, clustered contractions (rate 5-9 min-1, duration 20-120 s) in 19 subjects with ileostomies and four with endorectal pull throughs. In 13 children there were prolonged propagated contractions, > 60 mmHg in amplitude, > 15 s in duration, propagating at rates of 2-6 cm s-1 over at least 20 cm. The migrating motor complex was rare; in 55 h of fasting recording there were two phase III sequences. There are four distinctive features of ileal manometry recordings in children: random intermittent contractions, clustered contractions, prolonged propagated contractions and tonic contractions. The features of ileal motility differ from motility in the proximal small bowel.