纤维内镜评估Zenker 憩室和环咽肌失弛缓症患者的吞咽功能障碍。
Fiberoptic endoscopic evaluation of swallowing findings in individuals with Zenker's diverticulum and cricopharyngeal bar.
机构信息
Department of Otolaryngology-Head and Neck Surgery, University of California, Irvine, 200 S. Manchester Ave., Ste 400, Orange, CA, 92868-3201, USA.
出版信息
Eur Arch Otorhinolaryngol. 2020 Jul;277(7):2017-2021. doi: 10.1007/s00405-020-05922-y. Epub 2020 Mar 30.
PURPOSE
To assess fiberoptic endoscopic evaluation of swallowing (FEES) findings in individuals with cricopharyngeal bar (CPB) and Zenker's diverticulum (ZD).
METHODS
In this retrospective chart review spanning from 2010-2018, individuals diagnosed with CPB or ZD and undergoing FEES were identified. Patient demographics, radiographic studies, and treatments were recorded, and findings were compared between CPB, ZD of < 3 cm, and ZD ≥ 3 cm.
RESULTS
Sixty-one individuals consisting of 48 patients with ZD and 13 patients with CPB met inclusion criteria. Post-swallow hypopharyngeal reflux (PSHR) of undigested food bolus, present with or without Valsalva maneuver, was noted in 23%, 84%, and 75% of patients with CPB, ZD < 3 cm, and ZD ≥ 3 cm, respectively. The sensitivity and specificity of the finding for those with ZD were 81% and 83%, respectively. Of patients with ZD, reflux resolved in all but six individuals after surgery. Four of these patients underwent revision surgery with the reflux subsequently resolving, and two patients with persistent reflux were asymptomatic and did not desire further treatment.
CONCLUSIONS
PSHR is a good tool to identify the presence of a ZD and is less helpful to identify a CPB. Elimination of PSHR is a good tool to determine treatment success in patients with ZD and CPB.
LEVEL OF EVIDENCE
IV.
目的
评估纤维胃镜吞咽功能检查（FEES）在环咽肌失弛缓症（CPB）和Zenker 憩室（ZD）患者中的发现。
方法
在这项回顾性图表审查中，从 2010 年至 2018 年，确定了诊断为 CPB 或 ZD 并接受 FEES 检查的患者。记录了患者的人口统计学资料、影像学研究和治疗情况，并比较了 CPB、ZD<3cm 和 ZD≥3cm 之间的发现。
结果
61 名患者符合纳入标准，其中 48 名患者为 ZD，13 名患者为 CPB。在 CPB、ZD<3cm 和 ZD≥3cm 的患者中，分别有 23%、84%和 75%的患者在吞咽后出现未消化的食物团块的下咽反流（PSHR），伴有或不伴有瓦尔萨尔瓦动作。该发现对 ZD 患者的敏感性和特异性分别为 81%和 83%。在 ZD 患者中，除了 6 名患者外，手术后反流均得到缓解。其中 4 名患者接受了再次手术，反流随后得到缓解，而 2 名持续反流但无症状且不希望进一步治疗的患者也未进行治疗。
结论
PSHR 是识别 ZD 存在的一个很好的工具，但对识别 CPB 帮助不大。消除 PSHR 是确定 ZD 和 CPB 患者治疗成功的一个很好的工具。
证据水平
IV。
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