Shaw D W, Cook I J, Jamieson G G, Gabb M, Simula M E, Dent J
Department of Medicine, Royal Adelaide Hospital, South Australia.
Gut. 1996 Jun;38(6):806-11. doi: 10.1136/gut.38.6.806.
BACKGROUND/AIMS: To evaluate the role of upper oesophageal sphincter (UOS) compliance in dysphagia, the functional consequences of surgery were evaluated in eight patients with pharyngeal diverticula. The study examined the hypotheses that hypopharyngeal intrabolus pressure is an indicator of UOS compliance and that UOS opening and intrabolus pressure are normalised by surgery.
In eight patients and nine healthy controls, we measured the timing of swallow events, UOS relaxation, maximal UOS dimensions, intrabolus pressure, and trans-sphincteric bolus flow rates by simultaneous videoradiography and pharyngeal manometry.
Bolus flow rates were not changed by surgery. Surgery significantly increased UOS opening (p = 0.0001) and reduced hypopharyngeal intrabolus pressure (p = 0.0001). The slope of the relation between sphincter area and intrabolus pressure was steeper in patients than controls and was normalised by surgery. Surgery had minor effects on basal UOS tone and timing of swallow events.
Upper oesophageal sphincter compliance is poor in Zenker's diverticulum and is normalised by surgery. Hypopharyngeal intrabolus pressure, which correlates with resistance to trans-sphincteric bolus flow, is a useful indicator of UOS compliance. Intrabolus pressure may be a predictor of outcome after myotomy in pharyngeal dysphagia. Cricopharyngeal myotomy is a mandatory component of surgery for Zenker's diverticulum.
背景/目的：为评估上食管括约肌（UOS）顺应性在吞咽困难中的作用，我们对8例咽憩室患者手术的功能后果进行了评估。本研究检验了以下假设：下咽团块内压力是UOS顺应性的一个指标，并且手术可使UOS开放和团块内压力恢复正常。
我们通过同步视频放射成像和咽测压法，测量了8例患者和9名健康对照者的吞咽事件时间、UOS松弛、UOS最大尺寸、团块内压力以及跨括约肌团块流速。
手术未改变团块流速。手术显著增加了UOS开放（p = 0.0001）并降低了下咽团块内压力（p = 0.0001）。患者括约肌面积与团块内压力之间关系的斜率比对照者更陡，且手术使其恢复正常。手术对基础UOS张力和吞咽事件时间的影响较小。
Zenker憩室患者的上食管括约肌顺应性较差，手术可使其恢复正常。与跨括约肌团块流动阻力相关的下咽团块内压力是UOS顺应性的一个有用指标。团块内压力可能是咽吞咽困难行肌切开术后预后的一个预测指标。环咽肌切开术是Zenker憩室手术的一个必要组成部分。
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