食管憩室

食管憩室是指与食管腔相通之囊状突起,临床上较少见.我科近10年来17355例胃镜检查中仅发现27例(约0.16%),男性约为女性的2.4倍,年龄40岁以上者占85.2%.一般可分类为:(1)咽食管(Zenker)憩室,国外多见,报道常位于下咽缩肌与环咽肌之间的左后方.(2)食管中段憩室,国内多见,常伴于肺门水     

咽食管憩室

咽食管憩室系环状软骨近侧之咽部粘膜从咽后壁肌肉缺陷处疝出而成,又称为Zenker憩室。本病系后天性疾病,好发于成年人,尤以60岁后多见。憩室产生的机理众说纷纭,但不论其原因如何,一旦发生,则其大小、症状和并发症的发生率及严重程度均进行性增加。临床表现:吞咽时颈部有阻塞感,可伴特殊声响,有口臭。滞留在憩室内的未消化食物和唾液常可不自觉地返流而出。进食和饮水常可因憩室内滞留物返流入呼吸道而突然中止,可伴有呛咳。偶而,尤其在非常年老和虚弱的患者,可能仅有声嘶、气喘、肺炎和肺脓疡等表现。本病若不予及时治疗,可造成严重营养不良和肺部化脓性病变,病久者偶可发展为鳞癌。体检时,除     

经口内镜下食管憩室肌切开术治疗食管憩室的疗效分析

探讨经口内镜下食管憩室肌切开术治疗食管憩室的中远期疗效以及术后憩室复发的危险因素。方法　对2016年5月1日—2019年8月1日在东南大学附属中大医院接受经口内镜下食管憩室肌切开术治疗的31例食管憩室病例进行回顾性研究,主要观察术后Eckardt评分、治疗成功率和复发率,并采用多因素Logistic回归模型分析术后憩室复发的独立危险因素。结果　31例均顺利完成经口内镜下食管憩室肌切开术,术后随访（30.6±11.1）个月（20~63个月）。31例术前Eckardt评分（8.2±2.4）分,术后1个月（1.4±0.7）分,术后6个月（1.4±1.1）分,术后12个月（1.3±1.1）分,术后24个月（1.3±0.9）分,与术前比较,术后各随访时间点的Eckardt评分均有明显下降（P<0.001）。术后随访1、6、12、24个月的治疗成功率分别为96.8%（30/31）、90.3%（28/31）、90.3%（28/31）和90.3%（28/31）。有3例复发,总复发率为9.7%（3/31）。Logistic回归分析结果显示,病程（P=0.038,OR=1.041,95%CI：1.002~1.080）和术前Eckardt评分（P=0.024,OR=2.299,95%CI：1.117~4.728）是影响术后憩室复发的独立危险因素。结论　经口内镜下食管憩室肌切开术治疗食管憩室的中远期疗效理想,但病程长、术前Eckardt评分高者易复发。     

食管巨大憩室一例

患者男,60岁,因上腹胀痛5年加重2个月入院。患者5年来进食后上腹胀痛,返酸,偶有呕吐,呕吐物为少量胃内容物。近2个月来症状加重,食后伴胸痛及呕吐量较前增多,伴消瘦。于当地诊断为冠心病,治疗效果欠佳。入院后胸透检查示：心影后右侧囊状透亮区（图1）。上消造影示：食管下段右侧壁见一约10cm×8cm大小憩室影,食管吞钡造影剂大部份入憩室内滞留,食管黏膜线光滑柔软,贲门口开放正常。胃镜检查示：距门齿37cm齿状线上3cm处见后壁巨大憩室,大小约8cm×8cm×5cm,憩室内食物潴留,黏膜光滑（图2）。诊断：食管巨大憩室。     

食管憩室合并食管支气管瘘一例

患者女，26岁，因刺激性干咳半年，进食后加重1个月入院。患者半年前无诱因地出现刺激性干咳，无痰，无发热，盗汗、乏力。1个月前出现进食后咳嗽加重，伴有胸闷憋气，胸骨后不适，无恶心、呕吐、心悸。体格检查未见异常。     

膨出型食管憩室的处理

<正> 1968至1985年连续治疗的30例Zenker氏憩室(膨出型憩室)中有5例是过去在其它医院做过憩室切除后的复发病例,因憩室切除后复发病例较多促使我们复习用食管肌切开加或不加憩室固定术治疗的经验。21例男性,平均年龄64岁,7例大于80岁。所有病人都有反胃,87%有吞咽困难,43%有过吸入性肺炎,从胸片看3例为严重的,5例为中度的改变。症状的严重性和憩室大小没有关系。     

食管憩室合并出血1例

食管憩室合并出血１例张锦春，陈淑琴，岳文彬患者男，４４岁，中午进食后突感胸骨后胀闷，呕血约１００ｍｌ，呈鲜红色，不伴食物残渣，次日又呕血两次，行胃镜检查，见食管距门齿３８ｃｍ处前壁有一０．５ｃｍ×０．８ｃｍ憩室，囊腔内积血，冲净后见粘膜光软，血管纹理...     

食管憩室77例临床分析

目的 分析食管憩室患者的临床特点、胃镜表现、诊断及治疗经验.方法 回顾性分析2003年1月～2013年1月我院收治的77例食管憩室患者的临床资料.结果 77例患者中,咽食管(Zenker's)憩室9例,中段憩室52例,膈上憩室16例;经由上消化道钡餐检查发现食管憩室19例,胃镜检查发现58例;单发憩室68例,多发憩室9例;有临床症状及并发其他疾病患者35例;行外科手术治疗33例,其中1例死亡,1例治愈,26例恢复良好,症状基本缓解未见复发;2例经保守治疗后1例症状减轻,1例病情反复.结论 食管憩室患者症状不典型,食管动力紊乱是主要的临床表现,憩室以单发多见,胃镜是主要的诊断手段,有症状患者外科手术治疗是主要的治疗方式.     

食管壁层假憩室病

食管壁层假憩室病是一种不明原因的少见病,1960年Mendle首先报道。本文报道了6例并复习了英语文献所报道的43例。本病男性多于女性,发病年龄为8～83岁,好发于60～70岁,此病常伴有食管炎、食管反流,恶性肿瘤,食管蹼。25例作细菌培养,其中12例有念珠菌生长。本病大多数病例(76％)有吞咽困难的症状,仅有2例是急性发作,其余病例均为慢性病程,本文报道的6例均无吞咽困难,而因其他疾病如充血性心力衰竭、黑便、恶病质,呼吸困难等前来就诊,在上消化道钡餐检查     

多发性食管憩室一例报告

男,46岁。因间断性上腹痛一年余就诊。患者于一年前始觉劳动后或进食不当时上腹隐痛,有时伴嗳气,无返酸、呕吐。检查:心脏不大,心率68次,律齐。腹软无压痛。     

Esophageal cancer revealing a tracheal diverticulum

Tracheal diverticulum is a benign entity characterized by single or multiple invaginations of the tracheal wall, and is rarely encountered in clinical practice but frequently in postmortem examination as an incidental finding. Its combination with esophageal cancer is extremely rare. In this case report, we present a patient with these two lesions and analyze their correlation.     

Esophageal diverticulum exposed during endoscopic submucosal dissection of superficial cancer

Endoscopic submucosal dissection(ESD) is now widely accepted as a strategy to treat superficial esophageal neoplasms.The rate of adverse events,such as perforation,has been decreasing with the improvement of devices and techniques.In this paper,we report a case of esophageal cancer that had a diverticulum under cancerous epithelium.The diverticulum was not detected during preoperative examination,and led to perforation during the ESD procedure.Our case shows that,although rare,some diverticula can exist underneath the mucosal surface without obvious depression.If there is any sign of hidden diverticula during ESD,surgeons should proceed with caution or,depending on the case,the procedure should be discontinued to avoid adverse events.     

Esophageal diverticulum: New perspectives in the era of minimally invasive endoscopic treatment

Esophageal diverticula are rare conditions that cause esophageal symptoms, such as dysphagia, regurgitation, and chest pain. They are classified according to their location and characteristic pathophysiology into three types: epiphrenic diverticulum, Zenker's diverticulum, and Rokitansky diverticulum. The former two disorders take the form of protrusions, and symptomatic cases require interventional treatment. However, the esophageal anatomy presents distinct challenges to surgical resection of the diverticulum, particularly when it is located closer to the oral orifice. Since the condition itself is not malignant,minimally invasive endoscopic approaches have been developed with a focus on alleviation of symptoms. Several types of endoscopic devices and techniques are currently employed, including peroral endoscopic myotomy(POEM). However,the use of minimally invasive endoscopic approaches, like POEM, has allowed the development of new disorder called iatrogenic esophageal diverticula. In this paper, we review the pathophysiology of each type of diverticulum and the current state-of-the-art treatment based on our experience.     

Meckel's diverticulum

A 31 year-old man was seen with acute gastrointestinal bleeding. Superior mesenteric angiography revealed a vascular blush. This corresponded to an area of narrowing seen on the small bowel series. A diagnosis of malignant neoplasm was made preoperatively. At laparotomy, however, a Meckel's diverticulum with ulceration and stricture formation extending into the ileum was found. The histology showed gastric mucosa with ulceration. This report depicts small bowel narrowing secondary to Meckel's diverticulum.