上海交通大学学报（医学版）

›› 2011, Vol. 31 ›› Issue (6): 821-.doi: 10.3969/j.issn.1674-8115.2011.06.031

• 论著（临床研究） • 上一篇    下一篇

吞咽视频内镜检查对Zenker's憩室手术效果的评估作用

陈佳瑞1, Jean Lacau Saint Guily2, 王家东1   

  1. 1.上海交通大学 医学院附属仁济医院耳鼻咽喉头颈外科 上海交通大学耳鼻咽喉研究所, 上海 200001； 2.法国巴黎皮埃尔与玛丽·居里－巴黎第六大学附属Tenon医院耳鼻咽喉头颈颌面外科, 巴黎 75020
  • 出版日期:2011-06-28 发布日期:2011-06-27
  • 通讯作者: 王家东, 电子信箱: drjiadongw @yahoo.com.cn。
  • 作者简介:陈佳瑞（1985—）, 男, 住院医师, 硕士；电子信箱: dr_chenjiarui@yahoo.cn。

Role of videoendoscopic swallowing study in evaluation of surgical outcome of Zenker's diverticulum

CHEN Jia-rui1, Jean Lacau Saint Guily2, WANG Jia-dong1   

  1. 1.Department of Otolaryngology-Head &|Neck Surgery, Renji Hospital, Shanghai Jiaotong University School of Medicine, Otolaryngology Institute of Shanghai Jiaotong University, Shanghai 200001, China；2.Service d'ORL et Chirurgie Cervico-Faciale, Université|Pierre et Marie Curie, Paris 6, Hopital Tenon l'Assistance PubliqueHopitaux de Paris, Paris 75020, France
  • Online:2011-06-28 Published:2011-06-27

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摘要：

目的 探讨吞咽视频内镜检查（VESS）中观察到的潮汐症(RTS)现象对Zenker's憩室的诊断及手术疗效评估作用。方法 收集1998年5月—2010年4月法国巴黎Tenon医院耳鼻咽喉头颈颌面外科确诊并接受手术治疗的148例连续性Zenker's憩室病例的临床资料。对手术前和手术后VESS中RTS出现的情况进行回顾性分析；随机选择病例38例，记录术前VESS中RTS出现前的吞咽次数，并分析其与术前食道吞钡检查中记录的Zenker's憩室大小的关系；在VESS视频记录中回顾性寻找25例非Zenker's憩室的食道上段括约肌功能障碍患者吞咽过程中的RTS表现。结果 148例患者术前VESS中均有RTS表现。症状出现前吞咽次数与食道憩室大小无明显关联(P＞0.05)。术后对121例患者的随访发现，111例患者术后症状明显改善且VESS中RTS完全消失；10例患者症状复发，其中7例患者在平均随访37个月时VESS中再次出现RTS表现。25例非Zenker's憩室的食道上段括约肌功能障碍患者的VESS记录中未发现RTS表现。结论 VESS中观察到的RTS是Zenker's憩室的特征性表现。VESS可作为诊断Zenker's憩室的一项辅助检查及在随访过程中评估手术疗效的有效手段。

关键词: Zenker´s食管憩室, 潮汐症, 吞咽视频内镜

Abstract:

Objective To investigate the role of rising tide sign (RTS) in videoendoscopic swallowing study (VESS) in the diagnosis and evaluation of surgical outcome of Zenker's diverticulum. Methods The clinical data of 148 patients with Zenker's diverticulum undergoing operations consecutively between May 1998 and April 2010 were retrospectively analysed. VESS was performed preoperatively and postoperatively, and the results were compared for the presence of RTS. Videoendoscopic characteristics based on the times of swallow before onset of RTS and the preoperative size of Zenker's diverticulum on barium swallow were also compared with a randomly selected subset of 38 patients with Zenker's diverticulum. Finally, the videoendoscoic recordings of 25 patients with isolated upper esophageal sphincter dysfunction without Zenker's diverticulum were retrospectively reviewed to look for RTS. Results All these 148 patients presented RTS on the preoperative VESS. No correlation was observed between the times of swallow before onset of RTS and the size of diverticulum (P＞0.05). Follow-up data were available for 121 patients, and 111 patients were significantly improved in symptoms with complete disappearance of RTS. Recurrence of symptoms was observed during follow-up in 10 patients, 7 of whom had recurrence of RTS after a mean follow-up of 37 months. In contrast, RTS was never observed in the 25 patients with isolated upper esophageal sphincter dysfunction. Conclusion RTS observed in VESS is a specific feature of Zenker's diverticulum. VESS can be used as a supplementary tool for the diagnosis of Zenker's diverticulum and evaluation of surgical outcome during follow-up.

Key words: Zenker´s diverticulum, rising tide sign, videoendoscopy swallowing study