ACHALASIA OF ESOPHAGUS - PATHOLOGIC + ETIOLOGIC CONSIDERATIONS
ACHALASIA OF ESOPHAGUS - PATHOLOGIC + ETIOLOGIC CONSIDERATIONS
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DOI：
10.1097/00000658-196409000-00010
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发表时间：
1964-01-01
影响因子：
9
通讯作者：
ELLIS, FH
中科院分区：
文献类型：
--
作者：
CASSELLA, RR;SAYRE, GP;ELLIS, FH
对食管壁、迷走神经和迷走神经背侧运动核进行了病理学研究。34例食道失弛缓症患者和59例非食管病患者的标本构成了本报告的基础。68%的病例在组织学上观察到肌间神经节细胞变性或缺失，并与患者S症状的持续时间密切相关。在9例尸检标本中，7例在扩张段出现最明显的细胞丢失；在狭窄的食道远端段有细胞存在，尽管细胞数量减少了约50%。在光镜下，失弛缓症患者的胸段迷走神经与对照标本难以区分，但在电子显微镜下，总是可以看到类似于实验性沃勒氏变性的改变。在电子显微镜下观察，失弛缓症患者的食道平滑肌表现出三种与失神经萎缩相一致的细胞变化：肌丝从表膜上脱落、细胞萎缩和罕见的细胞肥大。2例食道失弛缓症患者迷走神经背侧运动核细胞计数显示，1例患者双侧背侧运动细胞丢失43%，2例患者一侧运动细胞丢失34%，另一侧运动细胞丢失38%。提示食道外迷走神经及其背侧运动核病变是食道失弛缓症的主要受累部位，其次为食道改变。
A pathologic study of the esophageal wall, vagus nerve and dorsal motor nucleus of the vagus nerve was undertaken. Specimens from 34 patients with esophageal achalasia and 59 control patients without esophageal disease form the basis of this report. Degeneration or absence of myenteric ganglion cells was noted histologically in 68% of cases and correlated well with the duration of the patient''s symptoms. In 7 of 9 necropsy specimens, the most marked cell losses were encountered in the dilated segment; cells were present in the narrowed distal segment of the esophagus though reduced in number by approximately 50%. The thoracic portion of the vagus nerve in patients with achalasia was indistinguishable from control specimens by light microscopy; however, with the electron microscope, changes resembling experimental wallerian degeneration were always seen. When studied with the electron microscope, esophageal smooth muscle in achalasia showed three principal types of cellular change consistent with denervation atrophy: myofilament detachment from surface membranes, cellular atrophy and, uncommonly, cellular hypertrophy. Cell counts of the dorsal motor nucleus of the vagus nerve in 2 patients with esophageal achalasia revealed losses of 43% of dorsal motor cells bilaterally in 1 patient and of 34% on 1 side and 38% on the other in the 2nd patient as compared with a control specimen. It is suggested than an extra-esophageal vagal lesion, either of the peripheral vagus nerve or of its dorsal motor nucleus, is the primary site of involvement in esophageal achalasia and that the esophageal changes are secondary.