DeMeester T R, Wernly J A, Bryant G H, Little A G, Skinner D B
Am J Surg. 1979 Jan;137(1):39-46. doi: 10.1016/0002-9610(79)90008-4.
The analysis of esophageal manometry and 24 hour esophageal pH monitoring in 266 consecutive patients indicates that the competency of the cardia depends upon the amplitude of the distal esophageal high pressure zone and the length of the abdominal esophagus. These two determinants of competency were examined using human esophagi in a unique in vitro model which allowed control of these parameters, as well as intraabdominal, intragastric, and intrathoracic pressures. The following principles of the function of the abdominal esophagus were graphically illustrated: (1) Competency of a segment of intraabdominal esophagus without intrinsic tone occurs only when intraabdominal pressure is equal to or greater than intragastric pressure. (2) Competency of a segment of intraabdominal esophagus without intrinsic tone is directly related to its length. (3) The length of intraabdominal esophagus necessary to maintain competency is indirectly related to variations in intraabdominal pressure. (4) Competency of a segment of intraabdominal esophagus is augmented by the presence of intrinsic tone, and the shorter the length, the greater the intrinsic tone needed. (5) Competency of a segment of intraabdominal esophagus is augmented by negative intrathoracic pressure. These findings beautifully illustrate the mechanical valvelike function of the abdominal esophagus and the objectives to be accomplished in the surgical treatment of gastroesophageal reflux.
对266例连续患者进行的食管测压及24小时食管pH监测分析表明，贲门的功能取决于食管远端高压区的幅度及腹段食管的长度。利用人体食管在一个独特的体外模型中对这两个决定功能的因素进行了研究，该模型可控制这些参数以及腹内压、胃内压和胸内压。以下腹段食管功能的原理通过图表进行了说明：（1）无固有张力的腹段食管只有在腹内压等于或大于胃内压时才具有功能。（2）无固有张力的腹段食管的功能与其长度直接相关。（3）维持功能所需的腹段食管长度与腹内压变化间接相关。（4）腹段食管的固有张力增强了其功能，长度越短，所需的固有张力越大。（5）胸内负压增强了腹段食管的功能。这些发现很好地说明了腹段食管的机械性瓣膜样功能以及胃食管反流手术治疗所要达到的目标。
