Heitmann P, Wolf B S, Sokol E M, Cohen B R
Gastroenterology. 1966 Jun;50(6):737-53.
Manometric features were correlated with roentgen configurations of the esophagogastric region in subjects with hiatal hernias and with rings by simultaneous cineradiographic and manometric study. The supradiaphragmatic pouch in small hiatal hernias was shown to have two functionally distinct components. Its upper portion (vestibule) had sequential contractile motor activity in response to swallowing. The lower portion was inactive and represented the true hernial sac. A weblike ring (Schatzki) or notches were often identified at the junction of these two segments. There was no peristaltic activity at or below this type of ring. A broad ring with contractile radiological behavior at the upper margin of the vestibule showed resting high pressure which fell on swallowing. This differed from the resting high pressure zone of normals in being shorter in length and showing an abrupt rather than gradual transition to contiguous pressures. Retrograde barium flow from hernial sac into the tubular esophagus was not seen when such a contractile A-ring was evident. Retrograde barium flow into the esophagus from the hernial sac occurred in those subjects not having a resting high pressure zone. Such reflux was delayed as long as the peristaltic wave persisted in the vestibular segment above the hernial sac. A constriction above the hernial sac during retrograde flow presumably represents a residual manifestation of the peristaltic wave, is transient, and is not associated with elevated resting pressure. The pressure inversion point was inconstant in its location in hiatal hernia subjects. It was often located at the site of the upwardly displaced high pressure zone, although a second pressure inversion point could be identified at the hiatal level on deep inspiration.
通过同步电影放射成像和测压研究，对患有食管裂孔疝和食管环的受试者的食管胃区域的测压特征与X线表现进行了相关性分析。小型食管裂孔疝的膈上憩室显示有两个功能不同的部分。其上部分（前庭）对吞咽有顺序性收缩运动活动。下部分不活动，代表真正的疝囊。在这两个部分的交界处常可发现网状环（沙茨基环）或切迹。在这种类型的环处或其下方没有蠕动活动。在前庭上缘有收缩性放射学表现的宽环显示静息高压，吞咽时压力下降。这与正常人的静息高压区不同，其长度较短，向相邻压力的转变是突然的而非逐渐的。当这种收缩性A环明显时，未见到钡剂从疝囊逆流至管状食管。在没有静息高压区的受试者中，钡剂从疝囊逆流至食管。只要蠕动波持续存在于疝囊上方的前庭段，这种反流就会延迟。逆流时疝囊上方的狭窄大概代表蠕动波的残余表现，是短暂的，且与静息压力升高无关。在食管裂孔疝患者中，压力反转点的位置不恒定。它常位于向上移位的高压区部位，尽管在深吸气时在食管裂孔水平可确定第二个压力反转点。
