実験的迷走神経切断後の食道運動とその病理組織学的変化について

抄録

Achalasia of the esophagus is a disease of unknown etiology characterized by disordered esophageal motility.
The purpose of this study was to investigate the difference between the motor disturbances of achalasia and that of the vagotomized esophagus.
Bilateral vagotomy was performed at the cervical portion in one side and in the hilum in another side on 70 dogs. The post-operative observation was done from 3 days to 10 months.
The effect of vagotomy were evaluated by the changes in esophageal motility, as determined by clinical observation, roentgenography and manometry. All tests of the motor function were done while these dogs were unanesthetized.
1. After bilateral vagotomy, they vomited all fluid and food immediately after recovering from anesthesia. Weight loss was remarkably recognized after vagotomy in all cases. The operative mortality rate within 2 weeks was 58.6% and 1 month survival rate was 27.1%.
2. Cinefluorography revealed marked dilatation of the lower portion of the esophagus and retension of contrast medium after swallowing in all of the vagotomized dogs. Esophagograms revealed a narrowing at the gastroesophageal junction and a mild dilatation of the terminal esophagus. No normal peristaltic wave was seen in all cases.
3. Manometrically, the frequency of the response after deglutition was seriously reduced and there was only observed a simultaneous contraction in the lower portion of the esophagus after vagotomy. The resting pressure at the gastroesophageal sphincter in vagotomized dog was significantly decreased and sphincteric relaxation was poor or absent. No recovery of peristaltic contraction was recognized even in 7 months after vagotomy.
4. The specimens of the esophagus were stained by Hematoxylin-eosin in 6 vagotomized dogs and the ganglion cells were examined.
Degeneration or absence of myenteric ganglion cells was not noted histologically.
5. The motility difference between the esophagus of achalasia and the vagotomized esophagus was that the resting pressure of the gastroesophageal sphincter was within normal limit in case of achalasia but decreased in vagotomized dogs. Furthermore, changes of the Auerbach's plexus was not observed in vagotomized dogs.