Wouters B, van Overbeek J J
ENT-Department, University Hospital Groningen, The Netherlands.
Acta Gastroenterol Belg. 1990 May-Jun;53(3):323-9.
The authors review the literature about the pathogenesis -still unknown- of Zenker's diverticulum as well as their experience of endoscopic treatment of this disease. From 1964 till 1988, they have treated endoscopically 507 patients, 323 by electrocoagulation, 184 by CO2-laser. The endoscopic procedure is described, consisting in precise division of the tissue bridge between the oesophagus and the diverticulum by micro-endoscopic surgery under general anesthesia. In recent years, the CO2-laser was found preferable, since it may cause less tissue necrosis and consequently less fibrous scar tissue. The results were very favourable, with more than 99% of the patients satisfied. Although many patients were old and in poor condition, only one patient died two days after operation because of cardiac failure. Complications such as bleeding, emphysema, mediastinitis and stenosis were seen in 5% of the patients, but in most cases there complications were mild and conservative therapy was sufficient. Stenosis occurred in 8 patients treated by electrocoagulation and in none of the patients treated by laser. Microendoscopic surgery is a safe and efficient method of therapy for the hypopharyngeal diverticulum.
作者回顾了关于Zenker憩室发病机制（仍不清楚）的文献以及他们在内镜治疗该疾病方面的经验。从1964年到1988年，他们共对507例患者进行了内镜治疗，其中323例采用电凝治疗，184例采用二氧化碳激光治疗。文中描述了内镜手术过程，即在全身麻醉下通过微型内镜手术精确分离食管与憩室之间的组织桥。近年来，发现二氧化碳激光更可取，因为它可能导致较少的组织坏死，从而产生较少的纤维瘢痕组织。结果非常令人满意，超过99%的患者表示满意。尽管许多患者年龄较大且身体状况不佳，但只有1例患者在术后两天因心力衰竭死亡。5%的患者出现了出血、气肿、纵隔炎和狭窄等并发症，但在大多数情况下，这些并发症较轻，保守治疗就足够了。8例接受电凝治疗的患者出现了狭窄，而接受激光治疗的患者无一出现狭窄。微型内镜手术是治疗下咽憩室的一种安全有效的方法。
