目的 分析食管胃连接处流出道梗阻(EGJOO)患者的临床特点和食管动力特征.方法 收集2015年1月至2018年1月遵义医学院附属医院因各种消化道症状就诊的663例患者的临床资料,经过胃镜、食管高分辨率测压(HRM)等检查除外胃肠道器质性病变,并将其中120例患者分为EGJOO组(71例)和非EGJOO组(49例).进一步将71例EGJOO患者根据综合松弛压分为轻度组41例、中度组20例和重度组10例.采用独立样本t检验和单因素方差分析进行统计学处理.结果 71例EGJOO组患者中,43.7% (31/71)表现为胸骨后胃灼热或反酸,32.4%(23/71)为梗阻感或吞咽困难,21.1% (15/71)为胸痛,21.1% (15/71)为其他不典型症状如呃逆、腹胀等,5.6% (4/71)为上腹痛.EGJOO组综合松弛压、食管下括约肌(LES)长度、LES静息压、食团内部压力均大于非EGJOO组[分别为(18.24±3.07) mmHg(1 mmHg =0.133 kPa)比(10.92±2.37) mmHg,(3.47±0.85) cm比(3.11±0.80) cm,(32.33±9.11) mmHg比(21.31±6.55) mmHg,(6.22±3.74) mmHg比(4.69±2.68) mmHg)],差异均有统计学意义(t=-13.947、-2.303、-7.706、-2.626,P均<0.05);EGJOO组LES松弛率和远端收缩积分(DCI)均低于非EGJOO组[(44.03±9.86)%比(53.86±11.33)%,(1 410.13±794.23) mmHg·s·cm比(1 741.86±894.16) mmHg·s·cm],差异均有统计学意义(t=5.046、2.136,P均<0.05).轻度组LES静息压高于中度组[(30.76±9.23) mmHg比(29.69±5.87) mmHg],中度组LES静息压低于重度组[(29.69±5.87) mmHg比(42.02±9.23) mmHg],差异均有统计学意义(均Tamhane检验,P=0.012、0.011);轻度组食团内部压力低于中度组和重度组[(5.16±3.41) mmHg比(8.02±2.58) mmHg和(7.46±3.48) mmHg],差异均有统计学意义(均最小显著差法检验,P均<0.05);轻度组DCI低于中度组[(1 241.41±606.12) mmHg·s·cm比(1 438.55±644.74) mmHg·s·cm],差异有统计学意义(Tamhane检验,P=O.011).结论 EGJOO患者临床症状以胃灼热或反酸、吞咽困难多见.EGJOO患者食管体部蠕动越弱,吞咽困难就越明显.食团内部压力升高是食管胃连接处松弛障碍的间接表现.
Objective To analyze the clinical features and esophageal motility characteristics of patients with esophagogastric junction outflow obstruction (EGJOO).Methods From January 2015 to January 2018,at Affiliated Hospital of Zunyi Medical College,the clinical data of 663 outpatients with various gastrointestinal symptoms were collected.Gastroscopy and esophageal high resolution manometry (HRM) were performed to exclude gastrointestinal organic lesions.The 120 patients were divided into EGJOO group (71 cases) and non-EGJOO group (49 cases).Furthermore,according to integrated relaxation pressure (IRP) the 71 EGJOO patients were divided into mild group (41 cases),moderate group (20 cases) and severe group (10 cases).Independent sample t test and one-way analysis of variance were performed for statistical analysis.Results Among 71 EGJOO patients,43.7% (31/71) showed post sternal heartburn or acid regurgitation,32.4% (23/71) showed obstruction or dysphagia,21.1% (15/71) showed chest pain,21.1% (15/71) showed other atypical symptoms such as hiccups and bloating,and 5.6% (4/71) showed upper abdominal pain.The IRP,lower esophageal sphincter (LES) length,LES resting pressure and intrabolus pressure (IBP) of the EGJOO group were higher than those of the non-EGJOO group ((18.24 ± 3.07) mmHg (1 mmHg =0.133 kPa) vs.(10.92 ± 2.37) mmHg,(3.47 ± 0.85) cm vs.(3.11 ±0.80) cm,(32.33 ±9.11) mmHg vs.(21.31 ±6.55) mmHg,(6.22 ±3.74) mmHg vs.(4.69 ± 2.68) mmHg),and the differences were statistically significant (t =-13.947,-2.303,-7.706 and-2.626;all P < 0.05).The LES relaxation rate and distal contractile integral (DCI) of the EGJOO group were lower than those of the non-EGJOO group ((44.03 ±9.86)% vs.(53.86 ±11.33)%,(1410.13± 794.23) mmHg·s·cm vs.(1 741.86 ±894.16) mmHg · s · cm),and the differences were statistically significant (t =5.046 and 2.136,both P < 0.05).The LES resting pressure of the mild group was higher than that of the moderate group ((30.76 ±9.23) mmHg vs.(29.69 ±5.87) mmHg);the LES resting pressure of the moderate group was lower than that of the severe group ((29.69 ± 5.87) mmHg vs.(42.02 ± 9.23) mmHg);and the differences were statistically significant (both Tamhane test,P =0.012 and 0.011).The IBP of the mild group was lower than that of the moderate group and the severe group ((5.16 ± 3.41) mmHg vs.(8.02 ± 2.58) mmHg and (7.46 ± 3.48) mmHg),and the differences were statistically significant (both least-significant difference test,both P <0.05).The DCI of the mild group was lower than that of the moderate group ((1 241.41 ± 606.12) mmHg · s · cm vs.(1 438.55 ± 644.74) mmHg· s· cm),and the difference was statistically significant (Tamhane test,P =0.011).Conclusions Heartburn,acid reflux and dysphagia are common clinical symptoms in EGJOO patients.The weaker the peristalsis of the esophageal body of EGJOO patients,the more obvious of dysphagia.Increased IBP is an indirect manifestation of esophagogastric junction relaxation disorder.