Zaninotto G, Costantini M, Boccù C, Anselmino M, Parenti A, Guidolin D, Ancona E
Department of Surgery, University of Padova School of Medicine, Italy.
Br J Surg. 1996 Sep;83(9):1263-7.
Pharyngo-oesophageal function was investigated in 12 patients with Zenker's diverticulum before and after cricopharyngeal myotomy with or without diverticulectomy using low-compliance, high-frequency oesophageal manometry. Nine healthy volunteers served as controls. The amount of muscle and connective tissue in the cricopharyngeal muscle was also measured by computerized morphometry and compared with findings in cadavers with no history of dysphagia. Preoperative manometry in patients with Zenker's diverticulum showed an incomplete relaxation of the upper oesophageal sphincter (UOS) (the residual UOS pressure at swallowing was 7.9 (range 1-20)mmHg in patients versus 0.2 (-12.5-14) mmHg in controls; P < 0.001) and increased pharyngeal intrabolus pressure (21 (range 0-52) versus 9 (range 0-16) mmHg; P < 0.01), with no pharyngo-oesophageal coordination abnormalities. Both parameters significantly decreased after myotomy. Patients with Zenker's diverticulum had significantly fewer muscle fibres in the cricopharyngeus and the muscle:connective tissue ratio was significantly lower (0.94 (range 0.8-1.4) in patients versus 1.5 (1.4-3.6) in controls; P < 0.05). This study supports the theory that Zenker's diverticulum is caused by an increased intrapharyngeal pressure at swallowing due to incomplete cricopharyngeal muscle relaxation resulting from localized sclerosis.
采用低顺应性、高频食管测压法，对12例Zenker憩室患者在进行或未进行憩室切除的环咽肌切开术前后的咽食管功能进行了研究。9名健康志愿者作为对照。还通过计算机形态测量法测量了环咽肌中的肌肉和结缔组织数量，并与无吞咽困难病史的尸体的测量结果进行了比较。Zenker憩室患者术前测压显示食管上括约肌（UOS）松弛不完全（患者吞咽时UOS残余压力为7.9（范围1 - 20）mmHg，而对照组为0.2（-12.5 - 14）mmHg；P < 0.001），且咽内团块压力升高（21（范围0 - 52）mmHg对9（范围0 - 16）mmHg；P < 0.01），无咽食管协调异常。肌切开术后这两个参数均显著降低。Zenker憩室患者环咽肌中的肌纤维明显较少，肌肉与结缔组织的比例显著较低（患者为0.94（范围0.8 - 1.4），对照组为1.5（1.4 - 3.6）；P < 0.05）。本研究支持以下理论：Zenker憩室是由于局部硬化导致环咽肌松弛不完全，吞咽时咽内压力升高所致。
