食道憩室

Oesophageal diverticula.

• M Duda
• M Dlouhý
• V Rocek
• M Rehulka
• K Vojácek
• Z Serý

抄録

1948年から1987年までにオロモウツ第一・第二外科で行われた91例（Zenker's 68例、傍頭蓋7例、epiphrenic 16例）の憩室切除術の治療経験をもとに、食道憩室の分類と病因について考察した。手術管理の戦術と手技、および単一疾患群におけるその結果について詳細に分析した。咽頭憩室は、上部食道括約筋の過緊張に伴う典型的な真性憩室である。この憩室の発生源と胃食道逆流との間には因果関係は証明されていない。胸部憩室は牽引性というよりも先天性のものであろう。上咽頭憩室は下部食道括約筋の過緊張から生じることが多い。先天性の場合もある。牽引の病因としては、憩室内の平滑筋腫の存在が考えられる。Zenker憩室の外科的治療は、憩室の切除と上咽頭筋切除である。傍頭蓋憩室の切除は、不快感が少なく、原則として非常に大きい場合にのみ適応となる。棘突起性憩室は通常、下部食道括約筋の緊張低下を伴う。このような場合には、Heller後筋切除術を行い、原則として憩室を切除します。

The classification and etiopathogenesis of oesophageal diverticula is discussed, based on the experience with the treatment of 91 (68 Zenker's, 7 parabronchial, and 16 epiphrenic) diverticulectomies performed at the First and Second Departments of Surgery in Olomouc from 1948 to 1987. The tactics and technique of surgical management and its results in the single groups of diseases are analyzed in detail. Parapharyngeal diverticula represent typical true diverticula associated with hypertonia of the upper oesophageal sphincter. No causal relationship could be proved to exist between the origin of this diverticulum and the gastrooesophageal reflux. Thoracic diverticula are probably rather of congenital than traction origin. Epiphrenic diverticula arise most often from hypertonia of the lower oesophageal sphincter. They can also be of congenital origin. Traction etiology could be observed in the presence of a leiomyoma in the diverticulum. The surgical management of Zenker's diverticulum consists in the excision of the diverticulum and cricopharyngeal myotomy. Excision of parabronchial diverticulum is seldom indicated for causing little discomfort, as a rule only when it is very large. Epiphrenic diverticula are usually associated with hypertonia of the lower oesophageal sphincter. In such cases, myotomy after Heller is performed and, as a rule, the diverticulum is excised.