Ardeleanu V, Chebac G R, Frâncuz L L, Păduraru D, Georgescu C, Frâncu L D
Clinical I Chirurgie, Spitalul Clinic de Urgenţ Sf. Apostol Andrei, Galaţi.
Chirurgia (Bucur). 2011 Jan-Feb;106(1):77-82.
In the last decade has seen an increase in hiatal hernia diagnosis. These issues led us to study and deepen the anatomic substrate of the changes that occur in the diaphragm muscle and periesophageal structures for optimum management of the disorder. The studied material was represented by fragments of the thoraco-abdominal diaphragm and tissues around the esophagus, biopsy sampling by classic open approach or celioscopic in patients with hiatal hernia, compared with a control group. Histological processing was carried out by current or special methods. After qualitative examining of the selected structures, quantification was performed using an interactive digital program. In the adult diaphragm with hiatal hernia was found in percentage volume reduction pillar of the diaphragm muscle fibers, increased the percentage of vascular lumina in the muscle portion of the crura, while the percentage volume of interstitial spaces increase. The changes of the percentage volume of connective tissue are significant, both crura suffering a fibrous transformation of muscle portions. Microanatomic changes are their quantitative objectivity suggest loss of elasticity and reduced functional capacity of diaphragm muscle in hiatal hernias.
在过去十年中，食管裂孔疝的诊断有所增加。这些问题促使我们研究并深入了解膈肌和食管周围结构发生变化的解剖学基础，以便对该疾病进行最佳管理。所研究的材料包括胸腹膈肌碎片和食管周围组织，通过经典开放手术或腹腔镜对食管裂孔疝患者进行活检取样，并与对照组进行比较。组织学处理采用常规或特殊方法。在对选定结构进行定性检查后，使用交互式数字程序进行定量分析。在患有食管裂孔疝的成年膈肌中，发现膈肌肌纤维柱的体积百分比减少，膈脚肌肉部分的血管腔百分比增加，而间质空间的体积百分比增加。结缔组织体积百分比的变化显著，膈脚的肌肉部分均发生纤维性转化。微观解剖学变化及其定量客观性表明，食管裂孔疝患者膈肌的弹性丧失和功能能力下降。
