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題名 | Scintigraphic Gastroesophageal Reflux Test in Patients Fed by Percutaneous Endoscopic Gastrostomy--Correlation with 24-Hour Esophageal pH Monitoring=核子醫學閃爍造影術用來診斷內視鏡經皮胃造口術患者胃食道逆流--以二十四小時食道酸度測量來評估 |
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作者 | 連漢仲; 張繼森; 陳儉鏗; 葉宏仁; 潘錫光; 楊勝舜; 蔡世傳; Lien, Han-chung; Chang, Chi-sen; Chen, Gran-hum; Yeh, Hong-zen; Poon, Sek-kwong; Yang, Sheng-shun; Tsai, Shih-chuan; |
期刊 | 中華民國消化系醫學雜誌 |
出版日期 | 19981200 |
卷期 | 15:4 1998.12[民87.12] |
頁次 | 頁1-8 |
分類號 | 415.509 |
語文 | eng |
關鍵詞 | 內視鏡經皮胃造口術; 胃食道逆流; 核子醫學閃爍造影術; Percutaneous endoscopic gastrostomy; Gastroesophageal reflux; Scintigraphy; |
中文摘要 | 核子醫學閃爍造景用來診斷內視鏡經皮胃造口術患者胃食道逆流為一簡單有用的 方式,本研究的目的在以二十四小時食道酸度測量來評估核子醫學閃爍造影的準確性。三十 五名神經性吞厭困難患者用胃造口術灌食接受 300ml 5% 葡萄糖溶液標識, 300 μ Ci Tc-99m DTPA 以平躺經胃造口灌食並以腹部束帶加壓至 100 mmHg, 其中十五名於不同天重 覆一次檢查以評估再現性,二十四小時食道酸度測量以胃鏡引導放在食道下括約肌上五公分 於閃爍造影同一天檢查。 結果二十四小時 pH 值小於 4 的時間百分比,在核子醫學閃爍造 影陽性患者較陰性者高( 22.36% ± 3.2% vs. 3.1% ± 0.83%, p<0.001 )。 在二十四小 時 pH 值小於 4 的時間百分比超過 4% 為陽性,其敏感度與特異性分別為 71% 及 93%;若 以二十四小時 pH 值小於 4 的時間百分比超過 14% 為較嚴重胃食道逆流,則其敏感度與特 異性分別為 100% 及 76% 閃爍造影術的再現性為 87%。 結論,胃食道逆流在胃造口術灌食 患者為一常見的問題,核子醫學閃爍造景術對診斷胃食道逆流為簡單且相當特異的方法,但 用來篩檢則受限於其低敏感度,然而在嚴重胃食道逆流易併發吸入肺炎危險之患者則為相當 敏感之工具。 |
英文摘要 | Gastroesophageal (GE) scintigraphy has been described as a simple method to detect gastroesophageal reflux in patients fed by percutaneous endoscopic gastrostomy (PEG). Our objective was to evaluate the accuracy of the scintigraphic method in comparison to 24- h esophageal pH monitoring. Methods: Thirty-five patients with neurological dysphagia who required PEG feeding were studied. Each subject received 300ml of 5% glucose water solution labeled 300μ Ci Tc-99m DTPA through the PEG tube in a supine position and an abdominal binder was applied to increase the pressure from 0 to 100 mmHg. Fifteen randomly selected patients underwent a repeated scintigraphic study on a separate day to evaluate the reproducibility. Twenty-four hour esophageal pH monitoring was positioned 5 cm above the lower esophageal sphincter under a standard meal on the same day of scintigraphy. Results: The percent time of 24-h with pH < 4 was significantly higher in the scintigraphic positive group than in the scintigraphic negative group (22.36%±3.2% vs. 3.1%±0.83%, p<0.001). When a cutoff value of 4% of total percent time with pH<4 was selected, the sensitivity was 71% and specificity was 93%; when a cutoff value of 14% was selected, the sensitivity was 100%, and the specificity was 76%. The reproducibility of scintigraphy was 87%. Conclusion: Scintigraphy is a simple, feasible and relatively specific tool for detecting GE reflux. Although its clinical application as a screening test for reflux may be limited by its low sensitivity, it may be a sensitive test in patients with prolonged GE reflux, for whom pulmonary aspiration is risky. |
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