Adams C W, Brain R H, Trounce J R
Virchows Arch A Pathol Anat Histol. 1976 Nov 22;372(1):75-9. doi: 10.1007/BF00429718.
The histopathology of 40 cases of achalasia of the cardia, 6 cases of oesophageal spasm-incoordination and 4 cases of scleroderma was examined. Three cases of carcinoma and 6 cases of reflux oesophagitis were used as a control group. A nearly complete loss of myenteric ganglion cells was found in the upper thickened segment in achalasia. Some surviving ganglion cells were found in the lower segments in half the cases of achalasia; in two cases counts were normal in this segment. The occurrence of neuronal chromatolysis in 9 biopsies of achalasia supports the view that an active disease process was involved. The preganglionic parasympathetic fibres in two cases of achalasia were normal in appearance and number; this somewhat limited evidence tends to count against a primary disorder of the preganglionic neurone in this condition. The 6 cases of oesophageal spasm-incoordination showed similar neuronal loss to that in the lower segment in achalasia. Possibly "oesophageal spasm" represent an early stage or incomplete expression of achalasia. One cases of scleroderma showed loss of ganglion cells, but the myenteric plexus was here involved by the disease process. None of the 9 cases in the control group showed any loss of ganglion cells or chromatolysis. Acute and chronic inflammation was not convincingly associated with loss of ganglion cells in either achalasia or oesophageal spasm.
对40例贲门失弛缓症、6例食管痉挛失调症和4例硬皮病患者进行了组织病理学检查。选取3例癌症患者和6例反流性食管炎患者作为对照组。在贲门失弛缓症增厚的上段发现肌间神经节细胞几乎完全缺失。在半数贲门失弛缓症患者的下段发现一些存活的神经节细胞；2例该段计数正常。9例贲门失弛缓症活检中出现神经元染色质溶解，支持存在活跃疾病过程的观点。2例贲门失弛缓症患者的节前副交感神经纤维外观和数量正常；这一有限证据倾向于反驳这种情况下节前神经元原发性疾病的观点。6例食管痉挛失调症患者的神经元丢失情况与贲门失弛缓症下段相似。可能“食管痉挛”代表贲门失弛缓症的早期阶段或不完全表现。1例硬皮病患者出现神经节细胞丢失，但肌间神经丛在此处受疾病过程影响。对照组9例患者均未出现神经节细胞丢失或染色质溶解。无论是贲门失弛缓症还是食管痉挛，急慢性炎症与神经节细胞丢失之间均无令人信服的关联。
