BIOMECHANICS OF CRICOPHARYNGEAL BARS
BIOMECHANICS OF CRICOPHARYNGEAL BARS
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DOI：
10.1016/0016-5085(90)91149-z
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发表时间：
1990-11-01
期刊：
影响因子：
29.4
通讯作者：
BRASSEUR, JG
中科院分区：
文献类型：
--
作者：
DANTAS, RO;COOK, IJ;BRASSEUR, JG
影像学上可见明显的颈咽肌条的患者通常被认为是颈咽肌痉挛，颈咽肌是上食管括约肌的主要肌肉组成部分。这种情况被称为“颈咽失弛缓症”。本研究的目的是确定环咽杆的发病机制。同时对6例颈咽肌条突出患者和8例对照志愿者进行咽部和食管上括约肌的视频荧光镜和测压检查。记录每例受试者吞咽2-30 mL钡剂的次数。对于不同的推注量，颈咽杆患者的咽部蠕动收缩正常，上食管括约肌轴向压力和松弛正常，上食管括约肌的血流速度正常，上食管括约肌打开的持续时间正常。颈咽肌条患者的主要异常是经括约肌钡剂流期间上食管括约肌的最大尺寸减小，上食管括约肌上游的团内压力增加。因此，即使上食管括约肌不能正常打开，推注内压的增加也能保持正常的经括约肌流速。总的来说，研究患者的一系列发现表明，其颈咽杆的潜在发病机制是肌肉顺应性降低，其中松弛的颈咽肌在吞咽过程中不能正常扩张。
Patients with a prominent cricopharyngeal bar visible on radiography are generally considered to have spasm of the cricopharyngeus, which is the major muscle component of the upper esophageal sphincter. This condition has been termed "cricopharyngeal achalasia". The aim of this study was to determine the pathogenesis of cricopharyngeal bars. Concurrent videofluoroscopic and manometric examinations of the pharynx and upper esophageal sphincter were performed in a cohort of six patients with prominent cricopharyngeal bars and in eight control volunteers. In each subject, swallows of 2-30-mL barium boluses were recorded. The patients with cricopharyngeal bars showed normal peristaltic contraction in the pharynx, normal axial upper esophageal sphincter pressure and relaxation, normal flor rate across the upper esophageal sphincter, and normal duration of upper esophageal sphincter opening for different bolus volumes. The major abnormalities in the patients with cricopharyngeal bars were reduced maximal dimensions of the upper esophageal sphincter during the transsphincteric flow of barium and increased intrabolus pressure upstream to the upper esophageal sphincter. Thus, the increase in intrabolus pressure preserved normal transsphincteric flow rates even though the upper esophageal sphincter did not open normally. Overall, the constellation of findings in the patients studied suggests that the underlying pathogenesis of their cricopharyngeal bar was reduced muscle compliance wherein the relaxed cricopharyngeus did not distend normally during swallowing.