Anatomic-manometric correlation of the upper esophageal sphincter: a concurrent US and manometry study
Anatomic-manometric correlation of the upper esophageal sphincter: a concurrent US and manometry study
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DOI：
10.1016/j.gie.2010.04.029
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发表时间：
2010-09-01
影响因子：
7.7
通讯作者：
Shaker, Reza
中科院分区：
文献类型：
--
作者：
Hernandez, Lyndon V.;Dua, Kulwinder S.;Shaker, Reza
背景资料：咽食管段通常称为上食管括约肌（UES），在咽和食管之间产生高压区（HPZ）。然而，UES-HPZ的确切解剖组成部分仍然不完全确定。目的：系统地定义咽食管连接部的各种组成部分的US签名，并确定这些结构如何有助于UES-HPZ的发展。设计：前瞻性实验研究。设置：三级学术医学中心。患者：本研究涉及18名健康志愿者。干预：我们研究了5名参与者使用高频超声微探头（US-MP）和同步荧光透视，另外13名参与者使用US-MP和同步测压。主要结果测量：UES-HPZ中各种肌肉的相对贡献。结果：测压时，UES-HPZ的中位长度为4.0 cm（范围3.0-4.5 cm）。观察到C形肌肉，被认为代表颅咽肌，中位长度为3.5 cm（范围2.0-4.0 cm）。在13名参与者中的10名（77%）的远端HPZ（食管至UES过渡区）观察到代表食管对UES的贡献的椭圆形构型。13名参与者中有7名（54%）在近端HPZ（UES至咽过渡区）观察到下缩肌的扁平结构。远端和近端HPZ分别有4 - 5层和3层壁。平均（+/- SD）肌肉厚度是相对恒定的沿着长度的UES-HPZ.Limitations：空气伪影在UES-HPZ.Conclusion：的配置和层的UES-HPZ变化沿着其长度。上食管是远端UES-HPZ的重要贡献者。（Gastrointest Endosc 2010;72：587-92.）
Background: The pharyngoesophageal segment commonly referred to as the upper esophageal sphincter (UES) generates a high-pressure zone (HPZ) between the pharynx and the esophagus. However, the exact anatomical components of the UES-HPZ remain incompletely determined.Objective: To systematically define the US signature of various components of the pharyngoesophageal junction and to determine how these structures contribute to the development of the UES-HPZ.Design: Prospective, experimental study.Setting: Tertiary Academic Medical Center.Patients: This study involved 18 healthy volunteers.Intervention: We studied 5 participants by using a high-frequency US miniprobe (US-MP) and concurrent fluoroscopy and another 13 participants by using the US-MP and concurrent manometry.Main Outcome Measurements: Relative contribution of various muscles in the UES-HPZ.Results: Manometrically, the UES-HPZ had a median length of 4.0 cm (range 3.0-4.5 cm). A C-shaped muscle, believed to represent the cricopharyngeus muscle, was observed for a median length of 3.5 cm (range 2.0-4.0 cm). The oval configuration representing the esophageal contribution to the UES was seen in 10 of 13 participants (77%) at the distal HPZ (esophagus to UES transition zone). The flat configuration of the inferior constrictor muscle was noted in 7 of 13 participants (54%) at the proximal HPZ (UES to pharynx transition zone). There were 4 to 5 wall layers versus 3 layers in the distal and proximal HPZ, respectively. The mean (+/- SD) muscle thickness was relatively constant along the length of the UES-HPZ.Limitations: Air artifacts in the UES-HPZ.Conclusion: The configuration and layers of the UES-HPZ vary along its length. The upper esophagus is a significant contributor to the distal UES-HPZ. (Gastrointest Endosc 2010;72:587-92.)