Loukas M, Wartmann Ch T, Tubbs R S, Apaydin N, Louis R G, Gupta A A, Jordan R
Department of Anatomical Sciences, School of Medicine, St. George's University, Grenada, West Indies.
Folia Morphol (Warsz). 2008 Nov;67(4):273-9.
The contributions of muscle fibers from the right and left diaphragmatic crura to the formation of the esophageal hiatus have been documented in several studies, none coming to a complete consensus on the number of anatomic variations or the prevalence of these variations in the human population. These variations may play a role in the pathogenicity of specific diseases that involve the esophageal hiatus, such as hiatal hernias. We examined a total of two hundred adult cadavers during 2000-2007. The variations in the diaphragmatic crura, particularly their muscular contributions to the formation of the esophageal hiatus, were grossly examined and revealed a bilateral occurrence of diaphragmatic crura in all 200 specimens. The results of the various morphological patterns of circumferential muscle fibers forming the esophageal hiatus were classified into six groups. The most common type (Type I, 45%) formed the esophageal hiatus from muscular contributions arising solely from the right crus. In Type II (20%) the esophageal hiatus was formed by muscular contributions from the right and left crura. In Type III (15%), the right and left muscular contributions arose from the right crus with an additional band from the left crus. Type IV (10%) showed that the right and left muscular contributions arose from the right crus, with two additional (anterior and posterior) bands arising from the left crus. Type V (5%) demonstrated the contributions arising solely from the left crus. In Type VI (5%) the right and left contributions originated from the left crus with two additional bands, one from the right crus and one from the left crus. These variations may play a role in the pathogenicity of specific diseases that involve the esophageal hiatus such as hiatal hernia, gastroesophageal reflux disease and Dunbar's syndrome.
多项研究记录了左右膈脚的肌纤维对食管裂孔形成的贡献，但对于解剖变异的数量或这些变异在人群中的发生率，尚无完全一致的结论。这些变异可能在涉及食管裂孔的特定疾病（如食管裂孔疝）的发病机制中起作用。我们在2000年至2007年期间共检查了200具成年尸体。对膈脚的变异，特别是它们对食管裂孔形成的肌肉贡献进行了大体检查，结果显示所有200个标本中均出现双侧膈脚。构成食管裂孔的环周肌纤维的各种形态模式的结果分为六组。最常见的类型（I型，45%）是食管裂孔仅由右侧膈脚的肌肉贡献形成。II型（20%）中，食管裂孔由左右膈脚的肌肉贡献形成。III型（15%）中，左右肌肉贡献来自右侧膈脚，左侧膈脚还有一条额外的束带。IV型（10%）显示左右肌肉贡献来自右侧膈脚，左侧膈脚还有两条额外的（前侧和后侧）束带。V型（5%）表明仅由左侧膈脚提供贡献。VI型（5%）中，左右贡献起源于左侧膈脚，还有两条额外的束带，一条来自右侧膈脚，一条来自左侧膈脚。这些变异可能在涉及食管裂孔的特定疾病（如食管裂孔疝、胃食管反流病和邓巴综合征）的发病机制中起作用。
