高精度食管动力.ppt

高精度食管功能分析系统( HRiM ) 为什么要测定食团的传输? ?压力监测无法预测或评估食团的传输?食管压力异常的患者可能食团传输正常?食管压力正常的患者可能食团传输存在异常?对非梗阻性吞咽困难、打嗝和食管清除功能障碍诊断有重要意义。?可以区分气体传输的方向。对每一次吞咽都进行评估,分成?食团完全传输?食团不完全传输食管动力异常的不同疾病中液体传输正常的比例(N=350) 0% 0% 51% 55% 95% 97% 100% 96% 100% 0% 20% 40% 60% 80% 100% achalasia scleroderma IEM DES normal nutcracker poor relaxing LES hypertensive LES hypotensive LES 244 71 33 125 30 33 bined Multichannel Intraluminal Impedance and Manometry Clarifies Esophageal Function Abnormalities: Study of 350 Patients; R. Tutuian & D. Castell; American Journal of Gastroenterology; May 2004; 1011-1019 这些患者食管测压存在异常,但是食管液体传输正常单纯测压技术(N=350) IEM 20% DES 9% normal 37% poor relaxing LES 9% hypertensive LES 7% hypotensive LES 1% achalasia 7% scleroderma 1% nutcracker 9% 29 % 的病人用单纯测压不能正确评估食团传输。 Combined Multichannel Intraluminal Impedance and Manometry Clarifies Esophageal Function Abnormalities: Study of 350 Patients; R. Tutuian & D. Castell; American Journal of Gastroenterology; May 2004; 1011- 1019吞咽困难病人的食团传输 Impedance Detected Abnormal Bolus Transit in Patients with Normal Esophageal Manometry. Sensitive Indicator of Esophageal Functional Abnormality?; Koya et al; Diseases of the Esophagus (2008) 21, 563 – 569 吞咽困难 N=51 食道压正常 N=576 食团传输正常食团传输异常 73 % 27 % 29 % 71 % Dysphagia Patients Have Significantly Higher Abnormal Bolus Transit MultiChannel Intraluminal Impedance for The Assessment of Post-fundoplication Dysphagia; Yigit, , Quiroga & Oelschlager; University of Washington; Diseases of the Esophagus (2006) 19, 382-388. Normal Manometry 83 % Abnormal Manometry 17 % Normal Manometry 86 % Abnormal Manometry 14 % 吞咽困难诊断 Dysphagia No Dysphagia Normal Bolus Transit 38 % Abnormal Bolus Transit 62 % Normal Bolus Transit 68 % Abnormal Bolus Transit 32 % 有吞咽困难无吞咽困难食团传输正常食团传输正常食团传输异常食团传输异常 Viscous & Liquid Bolus Transit in IEM Patients Normal Bolus Transit 28 % Moderate Impairment 35 % Severe Impairment 37 % Bolus Transit Assessment (100 IEM Patients) IEM defined as > 30 % of liquid swallows with con