MANOMETRY OF THE NORMAL UPPER ESOPHAGEAL SPHINCTER AND ITS ALTERATIONS IN LARYNGECTOMY
MANOMETRY OF THE NORMAL UPPER ESOPHAGEAL SPHINCTER AND ITS ALTERATIONS IN LARYNGECTOMY
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DOI：
10.1172/jci109372
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发表时间：
1979-01-01
影响因子：
15.9
通讯作者：
GATES, GA
中科院分区：
文献类型：
--
作者：
WELCH, RW;LUCKMANN, K;GATES, GA
用传统的3孔Honeywell固态探头、8腔径向灌注（PR）探头和周向敏感（CS）探头同时研究了正常人上食管括约肌（UES）的快速拉通压力分布，该探头设计用于测量UES压力（UESP），而不考虑探头方向。压力曲线数字化，并通过计算机进行分析。Honeywell探头记录的峰值压力明显低于其他2种方法，并且受试者内压力变化范围较大（平均变异系数为53%）。每例受试者使用CS探头测量的UESP是恒定的（平均峰值UESP，121 mm Hg;平均变异系数，15%）。前后RP探头UESP与CS探头压力相同。峰灌注前后UESP与圆周测量括约肌挤压。编写了计算机程序，允许RP探头压力在3维中映射。正常的3维图的特征在于峰压的前后加重以及一致的轴向不对称，前峰压出现在0.8 ± 0.5。0.2靠近咽部一厘米。在定义了正常的二维和三维UESP配置后，对接受过喉切除术的患者进行了研究。用RP探针测量的峰值压力降低到约50 mm Hg和径向压力不对称性消失。与正常值一样，CS探头压力对应于RP探头压力峰值。UES长度没有显著变化。三维成像显示轴向不对称也消失了。喉切除术所产生的解剖学改变消除了UESP不对称。
Rapid pull-through pressure profiles of the normal human upper esophageal sphincter (UES) were simultaneously studied with a conventional 3-orifice Honeywell solid-state probe, an 8 lumen radially perfused (PR) probe and a circumferentially sensitive (CS) probe designed to measure UES pressure (UESP) without regard to probe orientation. Pressure curves were digitized and analyzed by computer. The Honeywell probe recorded significantly lowr peak pressures than the other 2 methods and had wide intrasubject pressure variations (average coefficient of variation, 53%). UESP measured with the CS probe was constant for each subject (mean peak UESP, 121 mm Hg; average coefficient of variation, 15%). Anteroposterior RP probe UESP were identical to CS probe pressures. Peak perfused anteroposterior UESP correlates with circumferentially measured sphincter squeeze. Computer programs were written that allowed RP probe pressures to be mapped in 3 dimensions. Normal 3-dimensional maps were characterized by anteroposterior accentuation of peak pressures and also by consistent axial asymmetry with anterior peak pressures occurring 0.8 .+-. 0.2 cm closer to the pharynx. After defining the normal 2- and 3-dimensional UESP configuration, patients who had undergone laryngectomy were studied. Peak pressures measured with the RP probe decreased to .simeq. 50 mm Hg and radial pressure asymmetry vanished. Like normals, CS probe pressures corresponded to peak RP probe pressures. UES length did not change significantly. Three-dimensional mapping showed that axial asymmetry also vanished. The anatomic alterations produced by laryngectomy abolishes UESP asymmetry.