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Three-Dimensional High-Resolution Esophageal Manometry Study of the Esophagogastric Junction in Patients with Achalasia.

贲门失弛缓症患者食管胃结合部的三维高分辨率食管测压研究。

  • 影响因子:2.46
  • DOI:10.1007/s10620-019-05824-y
  • 作者列表:"Guillaumot MA","Léandri C","Leblanc S","Coriat R","Prat F","Chaussade S","Barret M
  • 发表时间:2020-04-01
Abstract

BACKGROUND:A novel three-dimensional high-resolution esophageal manometry provides a dynamic 360° representation of the pressure at the esophagogastric junction. AIMS:To describe the three-dimensional high-resolution esophageal manometry patterns of achalasia. METHODS:We retrospectively included all consecutive patients who underwent three-dimensional high-resolution esophageal manometry before and after treatment (pneumatic dilatation or per-oral endoscopic myotomy) for achalasia between November 2016 and July 2017. The distribution of the pressures at the esophagogastric junction on three-dimensional high-resolution esophageal manometry was determined. RESULTS:Eighteen patients were included. Mean integrated relaxation pressure was 20.7 mmHg, and median (range) Eckardt score was 7 (4-10). Nine patients were treated by pneumatic dilatation and seven by myotomy. Nine patients underwent three-dimensional high-resolution esophageal manometry after treatment. Before treatment, the esophagogastric junction pressure distribution was best observed at end expiration and during the 4 s of the integrated relaxation pressure measurement. During the integrated relaxation pressure, the lower esophageal sphincter was asymmetric in 12 patients with a high-pressure zone between the left and the posterior side of the esophagogastric junction. After treatment, five patients had a residual high-pressure point on the left or the posterior side of the esophagogastric junction. CONCLUSIONS:Three-dimensional high-resolution esophageal manometry allows a simple assessment of the pressure topography at the EGJ. In patients with achalasia, we found the esophagogastric junction pressure to be asymmetric with a peak pressure on the greater curvature side. Three-dimensional high-resolution esophageal manometry has the potential to guide initial and redo treatments.

摘要

背景: 一种新的三维高分辨率食管测压技术提供了食管胃交界处压力的360 ° 动态表示。 目的: 描述贲门失弛缓症的三维高分辨率食管测压模式。 方法: 我们回顾性纳入了2016年11月至2017年7月间在贲门失弛缓症治疗 (充气扩张术或经口内镜下肌切开术) 前后接受三维高分辨率食管测压的所有连续患者。通过三维高分辨率食管测压测定食管胃结合部压力分布。 结果: 共纳入18例患者。平均综合松弛压为20.7 mmHg,中位 (范围) Eckardt评分为7 (4-10)。9例采用气囊扩张术治疗,7例采用肌切开术治疗。9例患者治疗后均行三维高分辨率食管测压。治疗前,食管胃连接处的压力分布最好在终点呼气时和在综合松弛压力测量的4 s期间观察到。在综合松弛压力期间,12例患者的下食管括约肌不对称,食管胃结合部左侧和后侧之间有高压区。治疗后,5例患者在食管胃结合部左侧或后侧有残余高压点。 结论: 三维高分辨率食管测压可以简单地评估EGJ的压力形貌。在贲门失弛缓症患者中,我们发现食管胃连接处的压力与较大弯侧的峰值压力不对称。三维高分辨率食管测压具有指导初始和重做治疗的潜力。

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影响因子:2.98
发表时间:2020-01-01
DOI:10.1136/neurintsurg-2019-014962
作者列表:["Guo W","Liu H","Tan Z","Zhang X","Gao J","Zhang L","Guo H","Bai H","Cui W","Liu X","Wu X","Luo J","Qu Y"]

METHODS:BACKGROUND:The main surgical techniques for spontaneous basal ganglia hemorrhage include stereotactic aspiration, endoscopic aspiration, and craniotomy. However, credible evidence is still needed to validate the effect of these techniques. OBJECTIVE:To explore the long-term outcomes of the three surgical techniques in the treatment of spontaneous basal ganglia hemorrhage. METHODS:Five hundred and sixteen patients with spontaneous basal ganglia hemorrhage who received stereotactic aspiration, endoscopic aspiration, or craniotomy were reviewed retrospectively. Six-month mortality and the modified Rankin Scale score were the primary and secondary outcomes, respectively. A multivariate logistic regression model was used to assess the effects of different surgical techniques on patient outcomes. RESULTS:For the entire cohort, the 6-month mortality in the endoscopic aspiration group was significantly lower than that in the stereotactic aspiration group (odds ratio (OR) 4.280, 95% CI 2.186 to 8.380); the 6-month mortality in the endoscopic aspiration group was lower than that in the craniotomy group, but the difference was not significant (OR=1.930, 95% CI 0.835 to 4.465). A further subgroup analysis was stratified by hematoma volume. The mortality in the endoscopic aspiration group was significantly lower than in the stereotactic aspiration group in the medium (≥40-<80 mL) (OR=2.438, 95% CI 1.101 to 5.402) and large hematoma subgroup (≥80 mL) (OR=66.532, 95% CI 6.345 to 697.675). Compared with the endoscopic aspiration group, a trend towards increased mortality was observed in the large hematoma subgroup of the craniotomy group (OR=8.721, 95% CI 0.933 to 81.551). CONCLUSION:Endoscopic aspiration can decrease the 6-month mortality of spontaneous basal ganglia hemorrhage, especially in patients with a hematoma volume ≥40 mL.

影响因子:0.96
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DOI:10.1002/jcu.22762
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