Korn O, Braghetto I, Burdiles P, Csendes A
Department of Surgery, Clinical Hospital University of Chile, Santiago, Chile.
Dis Esophagus. 2000;13(2):104-7; discussion 108-9. doi: 10.1046/j.1442-2050.2000.00091.x.
Until now, it has not been quite clear which muscular fibers are cut when a cardiomyotomy for achalasia is carried out. In the present report, in a human achalasic gastroesophageal specimen, the mucosa of the stenotic segment was stripped off, allowing the fibers of the inner muscular coat to be seen. In addition, three cardiomyotomies at different sites were simulated. In achalasic specimens, the stenotic area is formed by the semicircular ('clasp') and oblique ('sling') muscular fibers. Different myotomies section these two muscular bands in distinct proportions. The stenotic segment in achalasia coincides topographically with the anatomic lower esophageal sphincter area. The site of cardiomyotomy is not irrelevant because this sphincter is not an annular muscle and the two muscular components of the sphincter can be sectioned in different ways. This may be important in post-operative results with regard to the relief of dysphagia and the appearance of gastroesophageal reflux.
到目前为止，进行贲门失弛缓症的贲门肌切开术时，究竟切断了哪些肌纤维尚不完全清楚。在本报告中，在一个人类贲门失弛缓症的胃食管标本中，剥去狭窄段的黏膜，使内层肌层的纤维得以显现。此外，还模拟了在不同部位进行的三次贲门肌切开术。在贲门失弛缓症标本中，狭窄区域由半圆形（“扣环”）和斜形（“吊带”）肌纤维形成。不同的肌切开术以不同比例切断这两条肌带。贲门失弛缓症的狭窄段在地形上与解剖学上的食管下括约肌区域重合。贲门肌切开术的部位并非无关紧要，因为该括约肌不是环形肌，其两个肌肉成分可以以不同方式切断。这对于吞咽困难缓解和胃食管反流出现方面的术后结果可能很重要。
