Venturi M, Bonavina L, Colombo L, Antoniazzi L, Bruno A, Mussini E, Peracchia A
Department of General Surgery and Surgical Oncology, University of Milan, Ospedale Maggiore Policlinico, I.R.C.C.S., Italy.
J Surg Res. 1997 Jun;70(1):46-8. doi: 10.1006/jsre.1997.5049.
The aim of this study was to investigate the biochemical basis of biomechanical and morphological alterations of upper esophageal sphincter, which have been reported in patients with Zenker's diverticulum. 4-L-Hydroxyproline (4-Hyp) (collagen), isodesmosine (Ides), and desmosine (Des) (elastin) contents were measured in samples of cricopharyngeal muscle (CPM) and muscularis propria of the esophagus below the CPM. The specimens were collected from seven patients operated for Zenker's diverticulum and eight cadavers, without esophageal and connective tissue disease, 4-Hyp was assayed colorimetrically, Ides and Des by high-performance liquid chromatography. Mean (+/-SEM) values were compared by Mann-Whitney U test. In patients, collagen content was significantly increased, both in CPM and in the muscularis propria of the esophagus below the CPM (P < 0.05). In CPM, Ides to Des and collagen to elastin ratios were significantly higher in patients than in controls (P < 0.05). Both the CPM and the upper muscular cuff of the esophagus appear to be involved in the pathogenesis of Zenker's diverticulum. This finding supports the extension of the myotomy to the muscularis propria of the esophagus below the CPM. The alterated Ides to Des ratio suggests a primary disease of CPM as a cause of Zenker's diverticulum.
本研究的目的是探讨Zenker憩室患者所报道的食管上括约肌生物力学和形态学改变的生化基础。测定了环咽肌（CPM）和CPM下方食管肌层样本中的4-L-羟脯氨酸（4-Hyp）（胶原蛋白）、异锁链素（Ides）和锁链素（Des）（弹性蛋白）含量。标本取自7例因Zenker憩室接受手术的患者和8例无食管及结缔组织疾病的尸体，4-Hyp采用比色法测定，Ides和Des采用高效液相色谱法测定。均值（±标准误）采用Mann-Whitney U检验进行比较。在患者中，CPM及CPM下方食管肌层的胶原蛋白含量均显著增加（P < 0.05）。在CPM中，患者的Ides与Des之比以及胶原蛋白与弹性蛋白之比均显著高于对照组（P < 0.05）。CPM和食管上部肌袖似乎均参与了Zenker憩室的发病机制。这一发现支持将肌切开术扩展至CPM下方食管的肌层。Ides与Des比值的改变提示CPM的原发性疾病是Zenker憩室的病因。
