小儿食管裂孔疝反流和手术抗反流机制的研究

目的了解小儿食管裂孔疝（ＨＨ）发生反流和手术抗反流的作用机制。方法２０例经钡餐造影确诊的ＨＨ患儿进行手术前后食管２４小时ｐＨ监测和食管动力功能检查。结果２０例患儿均有病理性胃酸反流；术后各项反流指标除了平均反流周期外均显著改善，下食管括约肌长度（ＬＥＳＬ）显著增加（从１．１７ｃｍ增加到１．９４ｃｍ．Ｐ＜０．０１）．主要是腹内食管段增加明显（从０．５４ｃｍ增加到１．３０ｃｍ，Ｐ＜０．０５）。胃内压降低（从２．８６ｍｍＨｇ降到１．７８ｍｍＨｇ，Ｐ＜０．０１）：术后腹内食管段长度影响治疗效果，长度长则疗效好（Ｐ＜０，０５）；手术前后下食管括约肌压力（ＬＥＳＰ）无显著差别（Ｐ＞０．０５）。结论小儿ＨＨ发生反流的机制是由于ＬＥＳ长度不足，主要是腹内食管段长度不足甚至消失及胃内压增高引起；手术抗反流的机制定增加了ＬＥＳ的长度，主要是增加了腹内食管段的长度。

The mechanism of reflux and antireflux surgery in children with hiatal hernia

Objective To investigate the mechanism of reflux of hiatal hernia(HH) and antireflux surgery in children. Methods Ambulatory 24-hr esophageal pH-metry and esophageal manometry were studied in 20 patients with HH confirmed by GI before and after surgery. Results AII cases showed pathological acid reflux. All parameters except the mean reflux time were significantly decreased postoperatively. Lower esophageal sphincter length (LESL) rose from 1 .17cm preoperatively to 1.94cm postoperatively (P<0.01), and an intraabdominal length of esophagus from 0.54cm to 1.30cm (P<0.05), lntragastric pressure was reduced from 2.86mmHg to 1.78mmHg (P<0.01)No significant difference in lower esophageal sphincter pressure (LESP) was found after operation as compared to that before operation. We also found that the effects of surgery were affected by intraabdominal length of lower esophageal segment (P< 0.05). Conclusion Most patients with infantile HH had gastroesophageal reflux in this study, with decreased LESL, in particular, the intraabdominal length of LES or even in its absence and increased intragastric pressure. The results provided objective eridence of the role of increasing the intraabdominal length of LES in the mechanism of antireflux surgery.