Williams R B, Ali G N, Hunt D R, Wallace K L, Cook I J
Department of Gastroenterology, The St. George Hospital, University of New South Wales, Sydney, Australia.
Am J Gastroenterol. 1999 Dec;94(12):3448-54. doi: 10.1111/j.1572-0241.1999.01507.x.
It is not known whether cricopharyngeal myotomy predisposes to esophagopharyngeal regurgitation. Using ambulatory, dual pharyngeal, and esophageal pH monitoring before and after cricopharyngeal myotomy, our aim was to determine the effect, if any, of myotomy on the frequency of esophagopharyngeal acid regurgitation.
We studied prospectively 18 patients who underwent cricopharyngeal myotomy for pharyngeal dysphagia (10 Zenker's, eight neurogenic dysphagia), of whom 17 agreed to undergo dual pH monitoring preoperatively, and 10 who agreed to both pre- and postoperative monitoring.
Symptoms of gastroesophageal reflux disease were present in 30%. Cricopharyngeal myotomy significantly reduced basal upper esophageal sphincter pressure by 49%, from 37+/-5 mm Hg to 19+/-3 mm Hg (p = 0.007). Esophagopharyngeal regurgitation was a rare event and the frequency of it did not differ between patients and healthy controls. Preoperatively, three regurgitation events in two patients did not differ from the postoperative frequency of a total of two events in the same two patients.
Increased esophageal acid exposure is common and esophagopharyngeal regurgitation is rare in unselected patients undergoing cricopharyngeal myotomy for pharyngeal dysphagia. Myotomy does not increase the frequency of esophagopharyngeal acid regurgitation in such patients.
目前尚不清楚环咽肌切开术是否会导致食管咽反流。通过在环咽肌切开术前后进行动态、双咽部和食管pH监测，我们的目的是确定肌切开术对食管咽酸性反流频率的影响（如果有）。
我们前瞻性地研究了18例因咽部吞咽困难接受环咽肌切开术的患者（10例Zenker憩室，8例神经性吞咽困难），其中17例术前同意进行双pH监测，10例同意术前和术后监测。
30%的患者存在胃食管反流病症状。环咽肌切开术使食管上括约肌基础压力显著降低49%，从37±5 mmHg降至19±3 mmHg（p = 0.007）。食管咽反流是一种罕见事件，患者与健康对照者之间其发生频率无差异。术前，两名患者发生3次反流事件，与术后这两名患者共发生2次反流事件的频率无差异。
在因咽部吞咽困难接受环咽肌切开术的未经选择的患者中，食管酸暴露增加很常见，而食管咽反流很少见。此类患者肌切开术不会增加食管咽酸性反流的频率。
