24小时食管pH监测电极的三种定位方法比较及其影响因素

目的 探讨食管测压法(M)、pH梯度定位法(P)及X线透视定位法(X)定位24 h食管pH监测电极的差别及其影响因素.方法 50例患者经M测定下食管括约肌距鼻外缘的长度,记录P定位的pH电极位置距鼻外缘的长度,在X线透视下观察电极位置与胃底贲门交界的距离.以差值绝对值≤2 cm为符合标准,分析三种定位方法的差异,并分析影响差别的相关因素.结果 经M、P、X定位的电极定位点距鼻外缘的长度分别为(37.9±2.9)、(40.8±4.4)和(40.7±5.3)cm,P与M以及X与M比较差异均有统计学意义(P＜0.01).P与M符合率62.0%(31/50);P与X符合率84.0%(42/50);X与M符合率58.0%(29/50).P较M偏向胃侧(2.9±3.9)cm.影响P与M差别的主要因素为年龄、身高和下食管括约肌的长度(P＜0.01或＜0.05).影响X和M的因素为身高和下食管括约肌长度(P＜0.05或＜0.01).结论 与M比较,P确定的位置倾向于偏向胃侧,在身材较高、下食管括约肌长度较长的受试者中易出现差异.X的变异不易确定,亦受身高的影响.

Differences of three positioning methods of the 24-hour esophageal pH catheter and relative factors

Objective To study the differences of esophageal manometry (M),pH set-up method (P) and X-ray (X) on positioning of the 24-hour esophageal pH catheter and relative factors. Methods Fifty subjects underwent M, then pH catheter was located by P and X. The difference between methods and the relative factors such as body height,lower esophageal sphincter (LES) length etc were analyzed. The difference of less than 2 cm between two methods was accepted. Results The length between the location determined by M,Pand X and nose were (37.9 ±2.9),(40.8 ±4.4) and (40.7 ±5.3) cm, respectively.There was significant difference between P and M as well as between X and M (P＜ 0.01 ). The coincidence rate was 62.0%(31/50) between P and M;84.0%(42/50) between P and X;and 58.0%(29/50) between X and M. Compared with P,M was (2.9 ±3.9) cm nearer to the stomach. Age, body height and LES length were main factors which affect the difference between P and M (P＜ 0.01 or ＜ 0.05),body height and LES length were main factors which affect the difference between X and M (P＜0.05 or ＜0.01). Conclusions Compared with M, the location determined by P is nearer to stomach. The location of X is varied. Body height and LES length are main relative factors.