Klein W A, Parkman H P, Dempsey D T, Fisher R S
Department of Medicine, Temple University School of Medicine, Philadelphia, Pennsylvania.
Gastroenterology. 1993 Nov;105(5):1362-9. doi: 10.1016/0016-5085(93)90140-8.
The contribution of the crural diaphragm to the gastroesophageal high pressure zone (HPZ) may be important in prevention of gastroesophageal reflux. The purpose of this study was to investigate the manometric characteristics of the thoracoabdominal junction in patients after surgical removal of the lower esophageal sphincter.
Ten patients with prior esophagogastrectomy were studied manometrically.
Esophageal manometry showed a HPZ and pressure inversion point distal to the anastomosis in 9 of 10 patients. Midrespiratory and end expiratory pressures were 14 +/- 7 and 6 +/- 4 mm Hg above intra-abdominal pressure, respectively. Breath holding caused inhibition of the phasic pressure component. This HPZ relaxed partially in response to deglutition (60% +/- 22%) and contracted in response to increased intra-abdominal pressure induced by either leg lifts or abdominal compression (delta HPZ/delta intra-abdominal pressure = 1.87 +/- 0.64 and 1.96 +/- 0.40, respectively).
This study shows an HPZ at the thoracoabdominal junction after surgical removal of the lower esophageal sphincter. We suggest that this sphincterlike HPZ is due to the crural diaphragm.
膈脚对胃食管高压区（HPZ）的作用在预防胃食管反流方面可能很重要。本研究的目的是调查手术切除食管下括约肌后患者胸腹部交界处的测压特征。
对10例曾行食管胃切除术的患者进行测压研究。
食管测压显示，10例患者中有9例在吻合口远端存在高压区和压力反转点。呼吸中期和呼气末压力分别比腹内压高14±7和6±4mmHg。屏气导致相位压力成分受到抑制。该高压区在吞咽时部分松弛（60%±22%），并在抬腿或腹部按压引起的腹内压升高时收缩（高压区变化量/腹内压变化量分别为1.87±0.64和1.96±0.40）。
本研究显示手术切除食管下括约肌后胸腹部交界处存在高压区。我们认为这种类似括约肌的高压区是由膈脚所致。
