Feussner H, Siewert J R
Chirurgische Klinik und Poliklinik TUM, Klinikum rechts der Isar, München, Germany.
Hepatogastroenterology. 1992 Apr;39(2):100-4.
The interrelationship between gastroesophageal reflux and Zenker's diverticulum remains unclear. The view that cervical diverticula are induced by gastroesophageal reflux disease (GER) is apparently supported by epidemiologic observations indicating that they occur only in populations with a high incidence of GER. However, it is difficult to prove causality on the basis of currently available physiological and pathophysiological investigations. The few data published to date now end to support a cryptogenic change in upper esophageal sphincter (UES) muscle motility characteristics instead of a reflux induced lesion to the UES. Clinical experience also shows that GER does not play a major role in individual cases of Zenker's diverticula, nor do many surgeons consider it a risk following cervical myotomy. This is confirmed by a very low complication rate even in large series of patients in whom no attempt was made preoperatively to rule out concomitant reflux disease. In conclusion, some facts suggest that reflux disease may be a cause of the development of Zenker's diverticulum. In the majority of cases, however, autochtonic structural lesions to the UES muscle fibers or other, as yet unknown, reasons are more probable.
胃食管反流与Zenker憩室之间的相互关系仍不明确。颈段憩室由胃食管反流病（GER）诱发这一观点，显然得到了流行病学观察结果的支持，这些观察表明颈段憩室仅发生在GER高发人群中。然而，根据目前可用的生理和病理生理学研究，很难证明其因果关系。迄今为止发表的少数数据现在倾向于支持食管上括约肌（UES）肌肉运动特征的一种不明原因改变，而非反流导致的UES病变。临床经验还表明，GER在个别Zenker憩室病例中并不起主要作用，许多外科医生也不认为在进行颈部肌切开术后GER是一种风险。即使在大量患者中术前未尝试排除合并的反流病，其并发症发生率也非常低，这证实了上述观点。总之，一些事实表明反流病可能是Zenker憩室形成的一个原因。然而，在大多数情况下，UES肌纤维的原发性结构病变或其他尚不清楚的原因更有可能。
