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NEJM：Zenkers憩室-病例报道

2017-11-30 xing.T MedSci原创

吞咽困难反流口臭Zenker's憩室
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Zenker's憩室是喉咽部从Killian三角缺损部位突出形成的疝，Killian三角由咽下缩肌和环咽肌围绕而成。这些憩室部分是由于食管上括约肌异常所致。小的憩室可无症状，无需治疗，而大的憩室可导致吞咽困难、反流、慢性吸入或咳嗽，甚至有可能需要进行手术。

患者为一名63岁男性，因进行性吞咽困难，体重减轻，返流和口臭8个月而到消化科就诊。

体格检查时没有发现明显的颈部肿块。实验室检查发现血清白蛋白水平偏低。钡餐检查显示食管上段钡剂在停滞在食管上段C5和C6椎体前有一个突起的病变（如图中箭头所示）。上消化道内镜检查发现咽食管憩室，或Zenker's憩室。



Zenker's憩室是喉咽部从Killian三角缺损部位突出形成的疝，Killian三角由咽下缩肌和环咽肌围绕而成。这些憩室部分是由于食管上括约肌异常所致。小的憩室可无症状，无需治疗，而大的憩室可导致吞咽困难、反流、慢性吸入或咳嗽，甚至有可能需要进行手术。

这个患者在内镜下进行Zenker's憩室切除术。在手术后3天，吞咽困难、反流和口臭症状消失；在治疗后8个月随访中，患者仍无上述症状。

原始出处：

Jean-Philippe Le Mouel, et al. Zenker’s Diverticulum.N Engl J Med 2017; http://www.nejm.org/doi/full/10.1056/NEJMicm1701620

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    2018-10-04 anminleiryan

    #ERS#

    0

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    2017-12-04 515404468_77917711

    学习学习

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    2017-12-04 大爰

    学习了谢谢分享!!

    0

  4. 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04 14:01:20 CST 2017, time=2017-12-04, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=266694, encodeId=609a266694fa, content=学习了谢谢分享!!, beContent=null, objectType=article, channel=null, level=null, likeNumber=66, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://img.medsci.cn/20200816/e4675a86ea694f12b82202b320dc2654/12f6b900498349e994ce8f516a584d6a.jpg, createdBy=09431951290, createdName=大爰, createdTime=Mon Dec 04 10:00:11 CST 2017, time=2017-12-04, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1522719, encodeId=dba91522e190f, content=<a href='/topic/show?id=14d853e8918' target=_blank style='color:#2F92EE;'>#憩室#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=31, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=53789, encryptionId=14d853e8918, topicName=憩室)], attachment=null, authenticateStatus=null, 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replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/Pw2csslt7CukWiabqiblnQAXaDEiaxhu025c3P0XshccTrbvGWBjKvnHIxbK3vqa80P7WGIFuicCFet97TicrNKpgB3TdabxP1vMh/0, createdBy=28851960965, createdName=榄枷檬, createdTime=Thu Nov 30 07:20:16 CST 2017, time=2017-11-30, status=1, ipAttribution=)]
    2017-12-01 zutt

    #憩室#

    0

  5. 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replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/Pw2csslt7CukWiabqiblnQAXaDEiaxhu025c3P0XshccTrbvGWBjKvnHIxbK3vqa80P7WGIFuicCFet97TicrNKpgB3TdabxP1vMh/0, createdBy=28851960965, createdName=榄枷檬, createdTime=Thu Nov 30 07:20:16 CST 2017, time=2017-11-30, status=1, ipAttribution=)]
    2017-12-01 Drhzm308

    谢谢.学习了

    0

  6. 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replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/Pw2csslt7CukWiabqiblnQAXaDEiaxhu025c3P0XshccTrbvGWBjKvnHIxbK3vqa80P7WGIFuicCFet97TicrNKpgB3TdabxP1vMh/0, createdBy=28851960965, createdName=榄枷檬, createdTime=Thu Nov 30 07:20:16 CST 2017, time=2017-11-30, status=1, ipAttribution=)]
    2017-11-30 半夏微凉

    学习了谢谢分享

    0

  7. 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createdAvatar=https://wx.qlogo.cn/mmopen/NUyjXTCJjo6Nx0VGA4QMDzOP8oAgnV4h51EjSfehJ9QxyiaSmw8PB56BhY8KXFSxHCibXrzcy4abrzSibXQPxJ9kzrLcJyhhB8a/0, createdBy=1d3b1672603, createdName=明月清辉, createdTime=Thu Nov 30 08:31:37 CST 2017, time=2017-11-30, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=265541, encodeId=561d2655418b, content=学习啦!谢谢分享!学习啦!谢谢分享!, beContent=null, objectType=article, channel=null, level=null, likeNumber=15, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/mONcle9pic3zSn0GqHrsfLK1wzJZRTON4gxYUibhUyOypBwMibC4R7SsppicGhz5Ogoy0VVq4CWnqaD2Moeib8RWxI5lOiaVmnxpan/0, createdBy=c53f1730331, createdName=tanxingdoctor, createdTime=Thu Nov 30 07:53:49 CST 2017, time=2017-11-30, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=265522, encodeId=9b922655222e, content=谢谢分享, beContent=null, objectType=article, channel=null, level=null, likeNumber=29, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/Pw2csslt7CukWiabqiblnQAXaDEiaxhu025c3P0XshccTrbvGWBjKvnHIxbK3vqa80P7WGIFuicCFet97TicrNKpgB3TdabxP1vMh/0, createdBy=28851960965, createdName=榄枷檬, createdTime=Thu Nov 30 07:20:16 CST 2017, time=2017-11-30, status=1, ipAttribution=)]
    2017-11-30 中医痴

    不错的.学习了.谢谢分享!

    0

  8. 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replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/Pw2csslt7CukWiabqiblnQAXaDEiaxhu025c3P0XshccTrbvGWBjKvnHIxbK3vqa80P7WGIFuicCFet97TicrNKpgB3TdabxP1vMh/0, createdBy=28851960965, createdName=榄枷檬, createdTime=Thu Nov 30 07:20:16 CST 2017, time=2017-11-30, status=1, ipAttribution=)]
    2017-11-30 明月清辉

    谢谢分享.学习了

    0

  9. 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replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/Pw2csslt7CukWiabqiblnQAXaDEiaxhu025c3P0XshccTrbvGWBjKvnHIxbK3vqa80P7WGIFuicCFet97TicrNKpgB3TdabxP1vMh/0, createdBy=28851960965, createdName=榄枷檬, createdTime=Thu Nov 30 07:20:16 CST 2017, time=2017-11-30, status=1, ipAttribution=)]
    2017-11-30 tanxingdoctor

    学习啦!谢谢分享!学习啦!谢谢分享!

    0

  10. 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replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/Pw2csslt7CukWiabqiblnQAXaDEiaxhu025c3P0XshccTrbvGWBjKvnHIxbK3vqa80P7WGIFuicCFet97TicrNKpgB3TdabxP1vMh/0, createdBy=28851960965, createdName=榄枷檬, createdTime=Thu Nov 30 07:20:16 CST 2017, time=2017-11-30, status=1, ipAttribution=)]
    2017-11-30 榄枷檬

    谢谢分享

    0

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诊断食管动力学障碍的高灵敏度测压法（HRM）是基于十次分开的咽水（SWS），不过这种方法不能代表食管在吞咽正常食物时的功能。

Stroke：急性脑桥梗死患者吞咽困难的预测因素！

由此可见，吞咽困难在孤立性脑桥梗死患者中经常发生。吞咽困难的临床和影像学预测可能有助于提供最佳的筛选，以防止并发症和改善长期预后。

BMJ：吞咽困难-案例报道

这是强直性脊柱炎罕见但可识别的并发症，其治疗选择仅限于手术减压。

Stroke.：受过训练的护士可通过早期筛查出卒中病人的吞咽困难症状而降低其肺炎患病率。

吞咽困难是中风患者的常见症状，并常导致严重的并发症，如吸入性肺炎。早期识别吞咽困难症状可减少这些并发症的发生。许多医院的现状是，由语言治疗师对吞咽困难进行筛选，这个方案在周末或节假日往往行不通（因为语言治疗师，不加班！）,这就延误了对吞咽困难的评估。

J Am Med Dir Assoc:老年患者误吸相关肺炎的诊断及研究进展

在临床上，口咽吞咽困难（OD）在老年患者中并不少见。而吞咽困难往往是导致老年患者误吸、窒息、肺部感染的高危因素。最近J Am Med Dir Assoc一篇文章针对老年患者的吞咽困难现状及诊断和管理进行了报道。该文章指出，OD的现象普遍存在与老年患者中，影响着27%-91%的70岁以上的老年人的生活。尽管OD能够通过临床手段被很好的诊断，但是在临床工作中医师一般很少针对患者进行系统的筛查，在老年社

NEJM：枕颈融合术后吞咽困难-案例报道

初次手术7天后该患者接受了第二次手术以调整颈枕角大小。调整手术后，该患者的吞咽困难症状得以解决。重复透视检查表明，鼻咽返流和延迟吸入不复存在。