Manometric Study of Hiatal Hernia and Its Correlation with Esophageal Peristalsis

The pathogenesis of gastroesophageal refluxdisease (GERD) is considered multifactorial, butalterations of the esophagogastric junction (EGJ) andhiatal hernia play a prominent role. The correlationsbetween hiatal hernia and the other pathogeneticfactors are as yet unclear, and they need to beinvestigated by a methodological approach based on newanatomic and functional criteria. Our aim was to study,by stationary manometry, the relationships betweensmall reducible hiatal hernia, identified by endoscopy,and esophageal peristalsis, in patients with and withoutGERD. According to the absence or presence of esophagitis (E), and the absence or presenceof hiatal hernia (H), 58 subjects were divided into fourgroups: controls 10; H 14; E 10; and HE 24. Stationarymanometry was performed by the rapid pull-through (RPT) technique, with catheter water perfused,to study the lower esophageal high pressure zone [loweresophageal sphincter (LES) and diaphragmatic crura] andthe parameters of esophageal peristalsis. In patients with hiatal hernia, the variouscombinations of peak and/or deflection of manometricline pressure identified five EGJ profiles, only one ofwhich reveals (by one-peak profile due to superimposed LES and diaphragmatic crura) the reducibilityof the hernia. The frequency of the five profiles wascalculated in the HE and H groups: a two-peak profilewas significantly more prevalent in these patients, although less so in the group with esophagitis.In E patients the distal amplitude and the distalpropagation of esophageal waves were significantly lowerthan in the other three groups (P < 0.05 vs controls and group HE; P < 0.01 vs group H).Furthermore, the distal amplitude was significantlyhigher in the group H than in the HE (P < 0.01). Ourresults show a better definition of hiatal hernia morphology, via the RPT technique, disclosingfive pressure profiles. In addition, a significant linkwas found between small reducible hiatal hernia withoutGERD and wave amplitude of the distal esophagus. The amplification of peristaltic clearing maybe considered the initial protective process againstacid reflux; the breakdown of this mechanism may triggerthe pathological sequence of GERD.     

创伤性膈疝的诊治（附23例分析）

目的 探讨创伤性膈疝的早期诊断和治疗。方法 对23例创伤性膈疝的资料进行回顾性分析。结果 术前确诊12例（52．2％）,漏诊10例（43．5％）,术中漏诊1例（4．3％）。全组治愈20例（87．0％）,死亡3例（13．0％）。术中漏诊1例,因肠绞窄脓毒性休克死亡。结论 提高认识、动态观察病情和X线胸片、及时全面的手术探查可降低误诊率。通过早期诊断和及时治疗,大多数创伤性膈疝可以治愈,死亡同膈疝本身无关,延误诊治是引起死亡的主要原因。     

创伤性膈疝的诊断

目的 总结创伤性膈疝诊断的经验教训,探讨提高早期诊断率的方法。方法 对４４例创伤性膈疝临床资料进行回顾性分析。结果 术前确诊１６例（３６．３６％）,误诊２８例（６３．６４％）,其中术中漏诊４例,全组治愈３２例（７２．７３％）、死亡１２例（２７．２７％）。结论 创伤性膈疝易于误诊,术前确诊率低,其原因是：对该病认识与警惕不够,该病缺乏特有症状。因此,提高对该病的认识,动态观察病情,全面分析其临床表现