无痛胃镜下高分辨率食管测压电极导管置入在贲门失弛缓症中的临床应用

Clinical application of painless gastroscopic placement of high-resolution esophageal manometry electrode catheter in achalasia patients

摘要:

摘要： 目的 探讨无痛胃镜辅助下高分辨率食管测压（HRM）电极导管置入技术在贲门失弛缓症（AC）患者中的临床应用价值，同时通过分析麻醉中及苏醒后HRM数据的变化评估其在麻醉中连续实时监测的意义。方法 回顾性分析该院2014年3月－2017年3月经无痛胃镜辅助下行HRM电极置入术的AC患者10例，实时监测患者在麻醉中及苏醒后的不同状态下HRM的检测数据，使用该中心20例健康志愿者常规HRM检测结果作为正常对照组，分别比较两种状态下反应食管胃连接部（EGJ）功能的参数变化情况[食管下括约肌压力（LESP）（包括呼吸最小值及呼吸平均值）和食管胃连接部收缩积分（EGJ-CI）]。结果 入组10例AC患者。其中3例无法耐受常规测压电极导管插入失败；3例测压电极导管插入后证实电极打折或未能通过EGJ；4例术前内镜见食管扩张明显或食物潴留的患者直接选择此方法进行监测。全部病例均于无痛胃镜辅助下将电极成功置入，同时HRM实时监测证实电极成功通过EGJ。苏醒后常规行HRM监测，符合芝加哥分类标准3.0（CCv3.0）AC Ⅰ型4例，Ⅱ型6例。麻醉状态下测压参数LESP（呼吸最小值及呼吸平均值）及EGJ-CI明显低于苏醒后，差异均有统计学意义（P <0.01）；麻醉状态下测压参数LESP呼吸最小值与正常对照组无明显差异（P >0.05），但LESP呼吸平均值和EGJ-CI均较正常对照组低，差异均有统计学意义（13.1 vs 18.8，P =0.012；26.2 vs 42.7，P =0.005）；然而在苏醒状态下EGJ-CI及LESP呼吸最小值明显高于正常对照组，差异均有统计学意义（69.1 vs 42.7，P =0.000；20.4 vs 12.6，P =0.012），全部病例完整松弛压（IRP）均大于15 mmHg，明显高于对照组（23.0 vs 8.3，P =0.000）。结论 对常规放置HRM电极导管困难的AC患者，无痛胃镜辅助下置入术是安全有效的，但HRM参数如LESP和EGJ-CI在麻醉状态下的监测对诊断和评估AC患者EGJ功能作用有限。

Abstract:

Abstract: Objective To investigate the clinical value of high-resolution esophageal manometry (HRM) electrode catheter implanted in achalasia patients assisted with painless gastroscope and to evaluate the significance of real-time continuous monitoring in anesthesia by analyzing the changes of HRM data during anesthesia and recovery. Methods 10 achalasia patients implanted HRM electrode catheter under painless gastroscope, were retrospectively identified during a 3-year period between March 2014 and March 2017, real-time monitored and the data of HRM during anesthesia and recovery was analyzed. The control subjects consisted of 20 healthy volunteers underwent HRM as part of our institutional normative data assessment. Lower esophageal sphincter pressure (LESP) metrics (end expiratory LESP and mean basal LESP), and Esophagogastric Junction Contractile Integral (EGJ-CI) were compared within and between groups. Results Ten achalasia patients fulfilled inclusion criteria, of which 3 patients were failed in routine electrode catheter insertion, 3 patients after insertion were confirmed that the electrode catheter turned over or not passed through the EGJ, 4 patients with esophageal dilatation or retention during preoperative endoscopy were selected directly for this method. Electrodes catheter were successfully implanted in all the patients, and successfully passed through EGJ confirmed by real-time monitoring of HRM. On routine HRM performed after anesthesia recovery, 4 patients had achalasia typeⅠ, 6 patients had typeⅡ according the Chicago classification criteria of 3.0 (CCv3.0). LESP (end expiratory LESP and mean basal LESP) and EGJ-CI during anesthesia were significant lower than those after anesthesia recovery (P < 0.01), the end expiratory LESP during anesthesia was no significant difference compared to controls (P > 0.05), but the median of mean basal LESP and EGJ-CI during anesthesia were significant lower compared to controls (13.1 vs 18.8, P = 0.012; 26.2 vs 42.7, P = 0.005); However, EGJ-CI and end expiratory LESP were significant higher compared to controls (69.1 vs 42.7, P = 0.000; 20.4 vs 12.6, P = 0.012) after anesthesia recovery, IRP in all the patients were greater than 15mmHg, significantly higher than that of the controls (P = 0.000). Conclusion Painless endoscopic assisted HRM electrode catheter placement is a safe and effective method for achalasia patients with difficulty insertion. However, monitoring the HRM parameters of LESP and EGJ-CI during anesthesia state have limited effect in the diagnosis and evaluation EGJ function in achalasia patients.