UPPER ESOPHAGEAL SPHINCTER AND RECURRENT LARYNGEALPALSY AFTER ESOPHAGECTOMYFORTHORACIC ESOPHAGEAL CANCER

食管上括约肌防止反流进入咽部。如果功能不正常，可能导致吸入性肺炎。我们研究了未麻醉的狗在喉返神经麻醉下去神经支配后括约肌的功能。通过测压法测量静止时括约肌的压力，测压器测量导管尖端周围的压力。然后测量球囊扩张至直径1.5、2.0、2.5cm及距括约肌5、10cm处的压力。然后，测量在离括约肌10 cm远的口侧灌注0.1 NHCl或NaOH期间的压力。这些研究首先在10只仅接受胃造口术进行测量的犬（对照组）中进行。对照组切断左侧喉返神经后（L组）、L组切断右侧喉返神经后（B组）、B组切断食管括约肌口侧7cm后（T组）重复测量。静息时的压力差异不显著。在每一组中，球囊充盈至任何直径的试验和在任一位置使压力升高至高于静止时的压力。然而，L、B和T组的压力显著低于对照组。当球囊扩张至距括约肌10cm时，T组的压力显著低于B组。当灌注盐酸或氢氧化钠时，对照组的压力逐渐增加，而其他组则没有。总之，虽然喉返神经在休息时不影响括约肌的功能，但它们是括约肌收缩的传入途径，作为食管扩张或化学刺激后的反射。颈段食管壁内神经网络可能是食管上括约肌收缩的另一条反射途径。

The upper esophageal sphincter prevents reflux into the pharynx. If it function improperly, aspiration pneumonia can result. We studied the functioning of the sphincter in unaanesthetized dogs after denervation under anesthesia of the recurrent laryngeal nerves. the pressure of the sphincter at rest was measured by manometry with a transduoer that measured pressurre around the tip of a catheter. Then the pressurre in response to inflation of a balloon to the diameter of 1.5,2.0 and 2.5cm and at 5 and 10cm aboral to the sphincter was measured. Next, the pressure during perfusion of 0.1 NHCl or NaOH 10cm aboral to the sphincter was measured. These studies were done first in 10 dogs that had undergone only gastrostomy for measurements (controls). Measurements were repeated after the left recurrent laryngeal nerve in the control was cut (L group), after the right recurrent laryngeal nerve in the L group was cut (B group), and after transsection of the esophagus 7cm aboral to the sphincter in the B group (Tgroup). The differences in the pressure at rest were not significant. In each group, balloon inflation to any diameter tested and at either position made the pressure rise above that at rest. This pressure in the L,B,and T groups, however, was significantly lower than in the controls. When the balloon was inflated to 2.5cm when it was 10cm aboral to the sphincter, the pressure in the T group was significantly lower than in the Bgroup. When HCl or NaOH were perfused, the pressure increased gradually in the controls, but not in the other groups. In conclusion, although recurrent laryngeal nerves did not affect the function of the sphincter at rest, they were the afferent routes of the contration by the sphincter as a reflex following distension or chemical stimulation of the esophagus. The intramural nerve network of the cervical esophagus may be another reflex route of contraction of the upper esophageal sphincter.