遊離空腸移植による下咽頭頚部食道再建術における内圧測定からみた再建食道の運動機能

Abstract

Nine cases with free jejunal reconstruction after hypopharyngolaryngoesophagectomy were evaluated reconstructed esophageal functions by manometric studies.The pharyngoesophageal high pressure zone disappeared, and the intra luminal pressure of freely transplanted jejunum was almost equal to atomospheric pressure, although the remaining intact esophagus including the lower esophageal high pressure zone had no significant changes on the resting pressure.Spontaneous movement of transplanted jejunum was observed for 26% of the examination time of four to five hours after meals. Movement similar to phase III intestinal contractions of Code's classification was seen intermittently for 43% of the spontaneous movement. Over night continuous recording showed that these rhythmic high pressure contractions were less predominant in the three hours after meals than in the four to twelve hours after meals.No propagating pressure waves were observed in the transplanted jejunum on deglutition with or without jejunal spontaneous movement, though synchronous spike waves were also seen in the pharynx and jejunum. However normal peristaltic waves in the residual esophagus and normal reluxation of lower esophageal sphincter also appeared.We speculate from this study that patients' symptoms of disswallowing or nasal regurgitation in the early postoperative period are mainly owing to phase III contractions occasionally encountered, because the pressure sometimes rise up to more than 100cmH2O and it may be higher than the degultition pressure or the obstructive pressure of nasopharyngeal cavity.