高分辨率测压评估胃底折叠术完整性的诊断准确性：Padova分类的验证
Diagnostic Accuracy of High-Resolution Manometry for Assessing Fundoplication Integrity: Validation of the Padova Classification.
文献信息
| PMID | 42823881 |
|---|---|
| 原文 | 在 PubMed 查看原文 ↗ |
| 发表日期 | 2026 |
| 作者 | Arianna Vittori |
| 作者单位 | Department of Surgery, Oncology and Gastroenterology, 1st General Surgery Unit, University of Padua, School of Medicine, Padua, Italy. |
| 期刊 | Neurogastroenterology and motility |
| SCI 分区 | Q2 |
| IF | 3.8 |
| 研究类型 | 临床研究 · 临床 |
| 所属专科 | 咽喉科 |
中文摘要
背景： 腹腔镜胃底折叠术（LF）后症状复发的原因尚未完全明确，目前研究集中于其机制。本研究旨在验证Padova分类，这是一种术后高分辨率测压（HRM）框架，用于区分功能性和缺陷性胃底折叠。
方法： 前瞻性收集了2010年至2025年间连续接受LF后HRM的患者数据，并将其分类为功能性和有效性LF（FELF）、胃底折叠术后流出道梗阻（PFOO）以及无效新屏障（INB）。主要分析涉及组间比较。通过计算每个诊断类别的敏感性、特异性、阳性预测值和阴性预测值，以复合参考标准（临床、放射学、内镜和pH监测标准）评估Padova分类的诊断准确性。使用受试者工作特征曲线分析评估术后整合松弛压（IRP）识别PFOO的诊断性能。
关键结果： 在373例患者中（42.4%为女性；中位年龄54岁，中位BMI 25.9 kg/m2；55.2%为Nissen术式，44.8%为Toupet术式），FELF、INB和PFOO分别见于58.7%、21.4%和18.0%的患者，其中PFOO最常见于Nissen胃底折叠术（p=0.001）。Padova分类对FELF的敏感性/特异性为94.7%/97.1%，对INB为88.8%/96.9%，对PFOO为100%/97.4%。术后整合松弛压能准确区分PFOO（AUC 0.959-0.984；截断值18.1 mmHg；敏感性97.7%-98.0%，特异性93.2%-96.8%），Padova分类与参考标准得出的ROC曲线无差异（p=0.12）。
结论： 本研究证实Padova分类在评估术后LF功能方面表现出强大性能。
英文摘要
BACKGROUND: Recurrent symptoms after laparoscopic fundoplication (LF) are not fully understood, with ongoing research focusing on their mechanisms. This study aimed to validate the Padova Classification, a postoperative high-resolution manometry (HRM) framework to distinguish functioning from defective fundoplications.
METHODS: Prospectively collected data from consecutive patients who underwent post-LF HRM (2010-2025) were analyzed and categorized as functioning and effective LF (FELF), post-fundoplication outflow obstruction (PFOO), and ineffective neo-barrier (INB). Primary analysis involved between-group comparisons. Padova Classification diagnostic accuracy was evaluated against a composite reference standard (clinical, radiological, endoscopic, and pH-monitoring criteria) by calculating sensitivity, specificity, positive predictive value, and negative predictive value for each diagnostic category. Diagnostic performance of postoperative integrated relaxation pressure (IRP) for identifying PFOO was evaluated using receiver operating characteristic curve analysis.
KEY RESULTS: Among 373 patients (42.4% female; median age 54 years, median BMI 25.9 kg/m2; 55.2% Nissen, 44.8% Toupet), FELF, INB, and PFOO were observed in 58.7%, 21.4%, and 18.0% of patients, respectively, with PFOO most frequently seen with Nissen fundoplication (p = 0.001). The Padova Classification showed sensitivity/specificity 94.7%/97.1% for FELF, 88.8%/96.9% for INB, and 100%/97.4% for PFOO. Postoperative integrated relaxation pressure accurately discriminated PFOO (AUC 0.959-0.984; cutoff 18.1 mmHg; sensitivity 97.7%-98.0%, specificity 93.2%-96.8%), with no difference between ROC curves derived from Padova Classification and reference standard (p = 0.12).
CONCLUSIONS: This study confirms that the Padova Classification demonstrates strong performance in assessing postoperative LF function.