出典(authority):フリー百科事典『ウィキペディア(Wikipedia)』「2015/06/11 00:27:02」(JST)
Zenker's diverticulum | |
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Classification and external resources | |
ICD-10 | K22.5 |
ICD-9 | 530.6 |
DiseasesDB | 31174 |
eMedicine | med/2777 |
Patient UK | Zenker's diverticulum |
MeSH | D016672 |
A Zenker's diverticulum, also pharyngoesophageal diverticulum, also pharyngeal pouch, also hypopharyngeal diverticulum, is a diverticulum of the mucosa of the pharynx, just above the cricopharyngeal muscle (i.e. above the upper sphincter of the esophagus). It is a false diverticulum (not involving all layers of the esophageal wall).
It was named in 1877 by German pathologist Friedrich Albert von Zenker.[1][2]
In simple words, when there is excessive pressure within the lower pharynx, the weakest portion of the pharyngeal wall balloons out, forming a diverticulum which may reach several centimetres in diameter.
More precisely, while traction and pulsion mechanisms have long been deemed the main factors promoting development of a Zenker's diverticulum, current consensus considers occlusive mechanisms to be most important: uncoordinated swallowing, impaired relaxation and spasm of the cricopharyngeus muscle lead to an increase in pressure within the distal pharynx, so that its wall herniates through the point of least resistance (known as Killian's triangle, located superior to the cricopharyngeus muscle and inferior to the inferior constrictor muscles). The result is an outpouching of the posterior pharyngeal wall, just above the esophagus.[3]
While it may be asymptomatic, Zenker diverticulum can present with the following symptoms:
It rarely, if ever, causes any pain.
Cervical webs are seen associated in 50% of patients with this condition.
Rarer forms of cervical esophageal diverticula are the Killian's diverticulum and the Laimer's diverticulum. Killian's diverticulum is formed in the Killian-Jamiseon triangle (located inferior to the cricopharyngeus on both sides of this muscle's insertion into the cricoid cartilage). Laimer's diverticulum is formed in Laimer's triangle (located inferior to the cricopharyngeus in the posterior midline above the confluence of the longitudinal layer of esophageal muscle). Laimer's triangle is covered only by the circular layer of esophageal muscle.
The simple barium swallow will normally reveal the diverticulum. An upper GI endoscopy also shows the diverticulum. Sipping contrast and taking a CT also gives a definite diagnosis.
If small and asymptomatic, no treatment is necessary. Larger, symptomatic cases of Zenker's diverticulum have been traditionally treated by neck surgery to resect the diverticulum and incise the cricopharyngeus muscle. However, in recent times non-surgical endoscopic techniques have gained more importance (as they allow for much faster recovery), and the currently preferred treatment is endoscopic stapling[4][5] (i.e. diverticulotomy with staples ). This may be performed through a diverticuloscope. Other methods include fibreoptic diverticular repair.[6]
Other non-surgical treatment modalities also exist, such as endoscopic laser, which recent evidence suggests is less effective than stapling.[7]
Zenker's diverticulum mainly affects older adults. It has an incidence of 2 per 100,000 per year in the UK, but there is significant geographical variation around the world.[8]
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English, ItalianIl diverticolo di Zenker è una estroflessione sacciforme della mucosa e sottomucosa che si sviluppa a livello della parete posteriore della giunzione faringoesofagea attraverso il triangolo di Killian. Il diverticolo di Zenker è il più frequente tra i diverticoli del tratto
リンク元 | 「ツェンカー憩室」「pharyngeal diverticulum」 |
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