From the site to distinguish, has the following several types: ① pharyngoesophageal diverticulum, occurred in the pharynx and esophagus connecting part; the esophageal diverticulum, found in the esophageal tracheal bifurcation, near; ③ epiphrenic diverticulum.
According to the mechanism can be divided into: ① pulsion diverticulum, because the intraluminal pressure is too high, the mucosa and submucosa from the muscle layer gap hernia outside of the cavity, also known as false diverticulum; ② traction diverticulum, lesions of mediastinal inflammatory by esophageal adjacent after contraction pull tube (full) form, also known as true diverticulum.
Pharyngoesophageal diverticulum is bulging diverticulum, its formation and pharynx, upper esophageal sphincter in swallowing complex mechanical activity and intraluminal pressure changes. The parts of the measurement results showed that swallowing incoordination and other abnormal situations, such as pharyngeal contraction occurs in the pharyngeal region (upper esophageal sphincter) closed, then pharyngeal pressure increases, swallowing food pills applying pressure on anatomical weak area, the local mucosa and submucosa hernia. For a long time, diverticulum increases gradually, sagging in the spine after esophageal pre clearance, even to the upper mediastinum.
2 clinical manifestations
Patients often have difficulty swallowing, and can effortlessly spits out a few hours ago swallow of undigested food, vomiting and posture. Reflux the easily aspiration during sleep. When drinking a gargling sound, the emergence of the neck when eating bag piece. The severity of symptoms and diverticulum size, and pharyngeal muscle dysfunction and ring is related to the degree of. Therefore, surgical treatment is aimed at moving obstacles local, rather than the diverticulum itself.
Because the pharyngoesophageal diverticulum have many symptoms and complications of surgical treatment, so as to. Diverticulum of very small, mild symptoms or frail patients, can use conservative treatment, such as after a meal, drink more water rinse diverticulum, changing position, neck massage to promote diverticulum emptying etc..
Operation treatment of a complete. Cricopharyngeal myotomy, whether for diverticulum, is a very effective treatment method for the cricopharyngeal muscle dysfunction and diverticulum itself. The diameter of 1 ~ 2cm diverticulum does not need to be cut, only from the diverticulum base starting all the cricopharyngeal muscle fiber as mucosal longitudinal incision, diverticulum can disappear. Large diverticulum is removed from its base. Operation with minimal complications.
Esophageal diverticulum is generally traction diverticulum, and subcarinal or bronchial lymph node tuberculosis or histoplasmosis related. The characteristics of small size, round shape, base broad, not easy to retention of food. In a few cases diverticulum is fine. Esophageal diverticulum than barium meal examination accidentally found, because there are no symptoms, it does not need treatment. But often the food residue and diverticulum inflammation, should operation excision, or along the longitudinal axis and after esophageal diverticulum and muscular layer of esophagus diverticulum, which disappeared.
Epiphrenic diverticulum generally occurs within the distal esophagus 10cm range, as the bulge diverticulum. Its occurrence and pharyngoesophageal diverticulum, and esophageal motor dysfunction or mechanical obstruction of distal esophagus. Esophageal cavity pressure increases, the oppression of mucosa and submucosa, muscular layer to make it through the protruding cavity.
2 clinical manifestations
Some patients have no symptoms, while others have a variety of symptoms, including difficulty swallowing and regurgitation is the most common, and retrosternal pain.
In addition to serving a barium meal examination, the disease should also be the esophageal manometry, esophageal motor dysfunction may exist at the same time to understand.
Epiphrenic diverticulum were mild or less than 3cm in diameter, more do not need treatment. If the dysphagia and chest pain symptoms progressive, diverticulum was draping shape, or the large diameter, all appropriate operation treatment.
Operation through left thoracic approach, except for the removal of the diverticulum, should also be longitudinal incision on the muscular layer of esophagus, aortic arch lower edge, down to the esophagogastric junction. This long myotomy for the treatment of esophageal motility disorders, especially strong contraction movement disorders is very effective. Preoperative examination as evidence of the lower esophageal sphincter in normal operation, for the destruction of the site.