Esophageal manometryWord文档下载推荐.docx
- 文档编号:15745592
- 上传时间:2022-11-15
- 格式:DOCX
- 页数:27
- 大小:675.30KB
Esophageal manometryWord文档下载推荐.docx
《Esophageal manometryWord文档下载推荐.docx》由会员分享,可在线阅读,更多相关《Esophageal manometryWord文档下载推荐.docx(27页珍藏版)》请在冰豆网上搜索。
RichardH.Holloway,B.Sc.(Med),M.B.B.S.,M.D.,F.R.A.C.P.
KeyPoints
∙Esophagealmanometryremainsthegoldstandardfortheassessmentofesophagealmotoractivity.However,itisnotaprimaryinvestigationandshouldbeperformedonlywhenthediagnosishasnotbeenachievedbycarefulhistory,bariumradiology,orendoscopy.
∙Themostrewardingindicationforesophagealmanometryisdysphagia.
∙Therearetwomaintypesofmanometricrecordingsystems:
perfusedandsolidstate.Bothhavestrengthsandweaknesses,andthechoiceofanyparticularsystemdependsonhowthesestrengthsandweaknessesareviewed.
∙Optimalrecordingofeitherpharyngealoresophagealmotilityrequiresanarrayofmultiplerecordingpointsthatspanthewholeregionofinterestinordertoprovideanintegratedpictureofmotorfunction.
∙Performanceofaccurateandhigh-fidelitymanometricrecordingsrequiresathoroughunderstandingofhowthemanometricsystemoperatesaswellascarefulattentiontotechnique.Poor-qualityrecordingsinevitablyleadtoerroneousinterpretation.
∙Themajorelementsoftheanalysisofpharyngoesophagealmanometryarethedegreeofupperesophagealsphincterrelaxation,theintegrityofpharyngalperistalsis,andintraboluspressure.Themajorelementsoftheanalysisofesophagealmotorfunctionaretheintegrityofesophagealperistalsisandthedegreeofloweresophagealrelaxation.Astructuredandsystematicassessmentoftheseelementsshouldleadtoamanometricdiagnosis
∙Achalasia,diffuseesophagealspasm,andnonspecificmotordisordershavedistinctmanometricfeatures.
Introduction
Disorderedpharyngealandesophagealmotorfunctionisacommoncauseofsymptoms,particularlydysphagia,chestpain,andthoseassociatedwithgastroesophagealreflux.Motorfunctioncanbeassessedbyavarietyofrecordingtechniquesincludingradiology,scintigraphymanometry,andmostrecentlyintraluminalelectricalimpedancemonitoring.Someofthesearecomplementary.Thegoldstandard,however,fortheassessmentofmotordisordersremainsmanometry.Manometricmeasurementofesophagealpressureisthemostdirectmethodforassessmentofmotorfunction.Onlymanometrycangiveinformationonthestrengthofcontractions.Butmanometryalsohasitsdisadvantages.Inassessingtheconsequencesofmotility,themovementofintraluminalcontentisonlybyinference.However,whenthediagnosisrequiresinformationaboutintraluminalflow,thiscanbeobtainedbycomplementarymeasurementoftransitbyradiology,scintigraphy,orintraluminalimpedancemonitoring.
Overrecentyears,esophagealmanometryhasbecomearemarkablysophisticatedtechnique.Technicaladvanceshaveledtothedevelopmentofavarietyofrecordingequipmentandapproachestomanometricmeasurementsandtheiranalysis.Thedevelopmentofpowerfulcomputerizedacquisitionsystems,alongwithhigh-fidelitymultichannelperfusionpumpsandmanometriccatheters,hasenabledhigh-resolutionmeasurementanddisplayofesophagealmotility.
Performanceoftechnicallyadequatemanometricrecordingsandinterpretationofthefindingsrequiresconsiderablebackgroundknowledge.Therehavebeenfourtechnicalreportsonesophagealmanometry.1,2,3,4Thisreviewdescribestheprincipalelementsofthemanometricsystem,theapproachestothemeasurementsthemselves,theclinicalapplicationofthetechniques,andthemanometricfeaturesofcommonpharyngealandesophagealmotordisorders.
ManometricMethods
ManometricEquipment
Anumberofoptionsareavailablefortheperformanceofesophagealmanometry.Allarecapableofobtainingadequaterecordings,andthechoiceofanyparticularsystemdependsultimatelyonhowthesestrengthsandweaknessesareviewed.Therearetwomajorchoices:
systemsthatdependonassembliesthatincorporateintraluminalsolid-statetransducers,andthosethatuseperfusedassembliesconnectedtoexternaltransducers.Bothmethodswhenusedproperlygiveaccuratemeasurementsofesophagealpressures.However,onlyintraluminaltransducerscanrecordaccuratelytheamplitudeofpharyngealpressuresalthoughtheclinicalvalueofthesehasyettobedemonstrated.
PerfusedManometricSystems
Perfusedmanometricsystemsrelyonthetransmissionoftheintraluminalpressurestoexternalpressuretransducersalongmanometricassembliesperfusedusuallywithdistilledwater.5Theyhaveanumberofadvantagesoverassembliescomposedofintraluminaltransducers.Theycanreadilyincorporatealargenumber(currentlyupto21)ofrecordingpointsinordertoprovidehigh-resolutionpressurerecordings.6,7,8Theserecordingpointscanbearrangedinawidevarietyofconfigurationsthatcanbetailoredtospecificrecordingapplications,forexample,pharyngeal,esophageal,gastroduodenal,andanorectalmotilit
- 配套讲稿:
如PPT文件的首页显示word图标,表示该PPT已包含配套word讲稿。双击word图标可打开word文档。
- 特殊限制:
部分文档作品中含有的国旗、国徽等图片,仅作为作品整体效果示例展示,禁止商用。设计者仅对作品中独创性部分享有著作权。
- 关 键 词:
- Esophageal manometry
![提示](https://static.bdocx.com/images/bang_tan.gif)