上部食道括約筋のX線学的研究

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There is still no consensus concerning clinical significance of the posterior indentation at the pharyngo-esophageal junction noted by radiological examination.In the present investigation, an attempt has been made to clarify whether there is an abnormal temporal relationship between pharyngeal peristaltic wave and pharyngo-esophageal sphincteric relaxation and contraction, and whether such a phenomenon could result from some abnormality of function of the upper esophageal sphincter, such as premature contraction or failure of relaxation.The subjects employed were normal adults, both male and female, ranged in age from twenty-three to seventy-four years. In all cases, cineradiographic studies have been made at 24 frames per sec. on 16 mm film, which consisted of lateral pharyngo-esophagram taken with the subjects in standing position and while swallowing a mouthful of fluid barium. In the lateral projection standard radiographs have also been taken to estimate the degree of indentation at rest and while Valsalva manoeuvre being performed.As to time relationship between the occurrence of this phenomenon and pharyngeal peristaltic wave, following two types were observed: (1) occurrence in succession with pharyngeal peristaltic wave, (2) occurrence immediately ahead of the passage of pharyngeal peristaltic wave. The first type was observed in 24 of 59 subjects, and appeared more frequently as age increased. Especially, in middle-age and beyond, 20 subjects out of 36 showed this phenomenon. The second type was observed in three cases aged more than 70 years, all of them being accompanied by a transitory diverticulum at the posterior wall of the hypopharynx just above indentation. During Valsalva manoeuvre, this phenomenon was observed in all the subjects, and its degree became more prominent than in the resting state. In 30 cases of 59, this test caused a depression of the posterior wall of the trachea at the level of the pharyngo-esophageal depression.The results of investigation are summarized as follows. Indentation showed no clear evidence for incoordination between the upper esophageal sphincter and the pharyngeal peristaltic wave. In three cases, however, premature closure of the sphincter was identified, and considered to be an important factor in the development of transitory diverticulum. According to observation with Valsalva manoeuvre, I reached the conclusion that the upper esophageal sphincter consists, in part at least, of the circular muscles of the upper end of the esophagus.
社団法人日本耳鼻咽喉科学会の論文

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木内宗甫
筑波大学臨床医学系耳鼻咽喉科

上部食道括約筋のX線学的研究

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