KISEP Head and Neck Korean J Otolaryngol 2001;44:633-9 인체상부식도괄약근의조직화학적특징에관한연구 모지훈 1 박민현 1 정영호 1 성원진 1 이동욱 2 김광현 1 성명훈 1 Histochemical Study of Muscula

Size: px

Start display at page:

Download "KISEP Head and Neck Korean J Otolaryngol 2001;44:633-9 인체상부식도괄약근의조직화학적특징에관한연구 모지훈 1 박민현 1 정영호 1 성원진 1 이동욱 2 김광현 1 성명훈 1 Histochemical Study of Muscula"

시완 탄
5 years ago
Views:

1 KSEP Head and Neck Korean J Otolaryngol 2001;44:633-9 인체상부식도괄약근의조직화학적특징에관한연구 모지훈 1 박민현 1 정영호 1 성원진 1 이동욱 2 김광현 1 성명훈 1 Histochemical Study of Musculature of the Human Upper Esophageal Sphincter Ji-Hun Mo, M 1, Min-Hyun Park, M 1, Young Ho Jung, M 1, Weon-Jin Seong, M 1, ong Wok Lee, M 2, Kwang Hyun Kim, M 1 and Mung-Whun Sung, M 1 1 epartment of Otorhinolaryngology Head and Neck Surgery, ollege of Medicine, Seoul National University, Seoul, 2 epartment of Otorhinolaryngology Head and Neck Surgery, ollege of Medicine, hungbuk National University, hungbuk, Korea STRT ackground and ObjectivesPharyngoesophageal musculature plays an important role in swallowing, and prevents aspiration and supraesophageal reflux. These muscles are closed during the resting state and opens with swallowing to allow the passage of food. n this study, the histochemical characteristics of the upper esophageal sphincter muscles in human were investigated. Materials and MethodsMuscle samples from the inferior pharyngeal constrictor, cricopharyngeus, upper esophageal muscle and sternocleidomastoid SM muscle were obtained from the healthy portion of nine laryngectomized specimen. We used the H&E staining for identifying the gross anatomy of these muscles, and the myofibrillar TPase staining and the NH-TR staining for differentiating the muscle fiber type. Resultsnalysis of the muscle fiber types of the upper esophageal sphincter muscle revealed a predominance of type in the cricopharyngeus 78.9% and the upper esophageal muscle 85.2%, and type in the inferior pharyngeal constrictor muscle 80%. n the SM muscle, the percentage of each fiber type was almost the same. The proportion of oxidative fibers within these muscles correlated well to that of the type fibers. onclusionthe distribution of the type fibers tended to be higher in the upper esophageal muscle than in the inferior pharyngeal constrictor. These findings about fiber types represents well the physiological features of each muscle, i.e. the inferior pharyngeal constrictors are capable of short rapid contraction and the upper esophageal muscles are capable of slow rhythmic movement. Korean J Otolaryngol 2001;44:633-9 KEY WORSeglutition Histocytochemistry Pharyngeal muscles. 633

2 634 Korean J Otolaryngol 2001;44:633-9

3 Table 1. ifferential histochemical reaction of muscle fibers to myofibrillar TPase staining Preincubation Type Type Type

에 잘 견디며, 형 근섬유는 수축시간이 빠르지만, 해당성 의 성질을 가지고 있으며 쉽게 피로해지고,

preincubation and darkly stained with acid preincubation.

preincubation and lightly () or moderately () stained

상부식도괄약근은 인두와 식도의 경계부위에서 평상시에 는 닫혀있다가 연하운동등의 생리적인 상태에만

H & E staining of sternocleidomastoid, inferior

4 인간의 상부식도괄약근의 조직화화적 특징에 관한 연구 은, 로 나눈다.4)6) 이것은 알칼리상태로 전처치한 염 색에서 형 근섬유는 연하게 염색되고, 산성상태로 전처치 한 염색에서 형 근섬유만 연하게 염색되는 성질을 이용 하는 방법이다. 근섬유의 생리학적 특징을 보면 형 근섬유 는 수축시간이 느리고, 산화성의 성질을 가지고 있고, 피로 에 잘 견디며, 형 근섬유는 수축시간이 빠르지만, 해당성 의 성질을 가지고 있으며 쉽게 피로해지고, 형 근섬유는 빠르게 수축을 하지만 어느 정도는 피로에 견디어 형과 형 근섬유의 중간정도의 성질을 가지고 있다. 산화효소로 염색 한 조직과 비교해보면 형 근섬유는 산화성과 해당성의 성질을 모두 가지고 있다고 한다.3) Fig. 1. Myofibrillar TPase staining. Type fibers are lightly stained with alkaline preincubation and darkly stained with acid preincubation. Type fibers are darkly stained with alkaline preincubation and lightly () or moderately () stained with acid preincubation. ph 10.5, ph 4.6 ( 100). 상부식도괄약근은 인두와 식도의 경계부위에서 평상시에 는 닫혀있다가 연하운동등의 생리적인 상태에만 열리는 인 두식도분절(pharyngo-esophageal segment)로, 하부인두 수축근의 일부, 윤상인두근, 상부식도근으로 이루어져 있는 것으로 생각되고 있다. 위의 결과는 식도내압검사(mano- Fig. 2. H & E staining of sternocleidomastoid, inferior pharyngeal constrictor, cricopharyngeus, upper esophageal muscle ( 100). Fig. 3. Myofibrillar TPase staining (ph 10.5) of sternoleidomastoid, inferior pharyngeal constrictor, cricopharyngeus, upper esophageal muscle ( 100). 636 Korean J Otolaryngol 2001 ;44 :633-9

모지훈 외 Fig. 4. Myofibrillar TPase staining (ph 4.

cricopharyngeus, upper esophageal muscle ( 100). Table 2.

number n % (S) 405 18.0 (± 4.7) 1524 67.8 (±11.8) 320 14.2 (± 4.1) 1050 78.9 (±12.

5 윤상인두근의 압력이 변함에 따라 같이 변하고, 연하운동시 에 감소하므로 뒷받침된다.1) 상부식도괄약근 중에 가장 중 75.

상부식도괄약근의 압력변화에 따라 60.8 근전도검사의 활동전위가 변한다고 알려져 있다.

5 모지훈 외 Fig. 4. Myofibrillar TPase staining (ph 4.6) of sternocleidomastoid, inferior pharyngeal constrictor, cricopharyngeus, upper esophageal muscle ( 100). Fig. 5. NH-TR staining of sternocleidomastoid, inferior pharyngeal constrictor, cricopharyngeus, upper esophageal muscle ( 100). Table 2. Fiber types in upper esophageal sphincter muscles Tissue Fiber type Total count number n % (S) (± 4.7) (±11.8) (± 4.1) (±12.8) (± 6.8) (± 1.1) (± 3.5) (± 3.4) (± 1.4) (±10.5) (± 7.7) P 2249 P UEM SM % of oxidative fibers metry)에서 압력이 높은 부위가 방사선학적 검사상 위의 근육들과 일치하기에 나온 것이다. 이는 식도내압검사상 가 장 압력이 높은 부위가 윤상인두근보다 넓은 부위에 걸쳐 분포하고, 또 하부인두수축근의 근전도검사의 활동전위가 34.5 윤상인두근의 압력이 변함에 따라 같이 변하고, 연하운동시 에 감소하므로 뒷받침된다.1) 상부식도괄약근 중에 가장 중 75.9 요한 구성요소는 윤상인두근으로 여겨지고 있고 윤상인두근 만이 지속적인 기저장력(basal tone)을 가지고 있고, 연하 운동시에 이완이 되고, 상부식도괄약근의 압력변화에 따라 60.8 근전도검사의 활동전위가 변한다고 알려져 있다.7) 하부인두수축근은 짧고 빠른 수축을 하여 음식물이 식도로 넘어갈 수 있도록 하는 역할을 한다. 이 근육에서 형 근섬유 (± 4.4) S standard deviation, P inferior pharyngeal constrictor, P cricopharyngeus, UEM upper esophageal muscle, SM sternocleidomastoid 가 많은 것은 이러한 근육의 특징과 잘 일치하고, 기존의 다 른 보고들도 이와 일치하는 결과를 보이고 있다. 본 연구에서 는 형 근섬유가 차지하는 비율이 82%가 나왔고, Hyodo 등은 80.6%(개), rownlow등은 82%(인간), Laurikanen 637

6 Table 3. Narrow fiber diametersmm of upper esophageal sphincter muscles Mean S P P UEM SM Pinferior pharyngeal constrictor, Pcricopharyngeus, UEMupper esophageal muscle, SMsternocleidomastoid, Sstandard deviation 638 Korean J Otolaryngol 2001;44:633-9

7 REFERENES 1) soh R, Goyal RK. Manometry and electromyography of the upper esophageal sphincter in opossum. Gastroenterology 1978;74: ) Mu L, Sanders. Neuromuscular organization of the human upper esophageal sphincter. nn Otol Rhinol Laryngol 1998;107: ) ubowitz V, rooke MH. Muscle biopsy: modern approach. Philadelphia: Saunders; ) rooke MH, Kaiser KK. Muscle fiber types: How many and what kind? rch Neurol 1970;23: ) Lawrie R. The relation of energyrich phosphate in muscle to myoglobin and to cytochrome-oxidase activity. iochem J 1953;55: ) :skeletal muscles in the investigation of neuromuscular disease. Neurology 1962;12: ) Lang M, Medda K, Mogan WJ, Shaker R. rainstem control of the upper esophageal sphincter in the cat. J Neurogastrointestinal Mot 1995;7:268. 8) Ryu S. histochemical study of swallowing muscles in the inlet of the esophagus. Otologia Fukuoka 1981;27: ) rownlow H, Whitmore, Willan PLT. quantitative study of the histochemical and morphometric characteristics of the human cricopharyngeus muscle. J nat 1989;166: ) Laurikanen E, itasalo K, Halonen P, Falck, Kalimo H. Muscle pathology in idiopathic cricopharyngeal dysphagiaenzyme histochemical and electron microscopic findings. Eur rch Otorhinolaryngol 1992;249: ) Hyodo M, ibara R, Kawakita S, Yumoto E. Histochemical study of the canine inferior pharyngeal constrictor muscle: mplications for its function. cta Otolaryngol 1998;118: ) onington, Mahon M, Whitmore. histological and histochemical study of the cricopharyngeus muscle in man. J nt 1988; 156: ) Sasaki T, Kim YH, zibulka. Motor innervation of the human cricopharyngeus muscle. nn Otol Rhinol Laryngol 1999;108: ) Lamere F. nnervation of the larynx. m J nat 1932;51: ) Sprague JM. The innervation of the pharynx in the rhesus monkey and the formation of the pahryngeal plexus in primates. nat Rec 1944;90: ) rok HJ, opper MP, Stroeve RJ, Ongerboer de Visser W, Venkervan Haagen J, Schouwenburg PF. Evidence for recurrent laryngeal nerve contribution in motor innervation of the human cricopharyngeus muscle. Laryngoscope 1999;109: ) Medda K, Lang WJ, odds WJ, hristl M, Kern M, Hogan WJ, et al. orrelation of electrical and contractile activities of the cricopharyngeus muscle in the cat. m J Physiol 1997;273:G

1548 Fig. 1. Laryngeal preparation for the laryngeal chemoreflex in puppy. Thyroid cartilage was retracted and bipolar, concentric needle electrode wa

1548 Fig. 1. Laryngeal preparation for the laryngeal chemoreflex in puppy. Thyroid cartilage was retracted and bipolar, concentric needle electrode wa KISEP Head and Neck Korean J Otolaryngol 1999;42:1547-54 강아지의후두화학반사에대한실험적연구 박한규 김광문 홍원표 김영호 김명상 김동영 Experimental Study of Laryngeal Chemoreflex in Puppies Han Q Park, MD, Kwang-Moon Kim, MD, Won Pyo Hong,