ATTENUATION OF ESOPHAGEAL SHORTENING DURING PERISTALSIS WITH HIATUS-HERNIA
ATTENUATION OF ESOPHAGEAL SHORTENING DURING PERISTALSIS WITH HIATUS-HERNIA
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DOI：
10.1016/0016-5085(95)90748-3
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发表时间：
1995-12-01
期刊：
影响因子：
29.4
通讯作者：
POUDEROUX, P
中科院分区：
文献类型：
--
作者：
KAHRILAS, PJ;WU, S;POUDEROUX, P
背景与目的：关于食管蠕动过程中食管缩短的定量信息很少。方法：7名志愿者和11例裂孔疝患者（n = 11）在食管鳞柱连接处及近端3-5 cm处经内镜固定金属夹，观察裂孔疝对纵向肌肉介导的食管收缩的影响。在仰卧位和直立位（有或没有腹部压迫）吞钡期间，使用同步测压法和视频透视法评估食管下括约肌的位置和轴向夹的运动。结果：以鳞柱连接处与膈间隙的接近程度来定义三组受试者：1组小于或等于0 cm；第二组，在0 ~ 2 cm之间；第三组，大于等于2cm。食管蠕动性缩短逐渐减少，再延伸逐渐延长，食管远端段收缩程度随着裂孔疝程度的加重而减少。在体位或腹部压迫下，相对于裂孔，鳞状柱连接处的活动度最小。结论：在蠕动过程中，纵向肌肉收缩通常会导致横膈膜上方的鳞状柱连接处短暂升高。食管初次蠕动时的缩短随着裂孔疝程度的增加而减少，这表明膈食管附着物对纵向肌肉收缩的反对减弱。
Background & Aims: Minimal quantitative information exists on esophageal shortening during peristalsis in the human esophagus. The aim of this study was to ascertain the effect of hiatus hernia on longitudinal muscle-mediated peristaltic esophageal shortening, Methods: Seven volunteers and 11 patients with hiatal hernia had metal clips endoscopically affixed at the squamocolumnar junction and 3-5 cm proximal to it (n = 11). Location of the lower esophageal sphincter and axial clip movement were assessed using concurrent manometry and videofluoroscopy during barium swallows in a supine and upright posture with and without abdominal compression. Results: Three subject groups were defined by the proximity of the squamocolumnar junction to the diaphragmatic hiatus: group 1, less than or equal to 0 cm; group 2, between 0 and 2 cm; and group 3, greater than or equal to 2 cm. Peristaltic esophageal shortening was progressively diminished, re-elongation progressively prolonged, and the degree of contraction observed in the distal esophageal segment reduced with progressive degree of hiatus hernia, There was minimal mobility of the squamocolumnar junction relative to the hiatus with posture or abdominal compression. Conclusions: Longitudinal muscle contraction during peristalsis normally causes transient elevation of the squamocolumnar junction above the diaphragm. Esophageal shortening during primary peristalsis is reduced with increasing degree of hiatus hernia, suggesting that there is diminished opposition of longitudinal muscle contraction from the phrenoesophageal attachments.