Venous outflow from the thoracic esophagus occurs. Esophagus in endoscopic image

It is generally accepted that the abdominal esophagus is covered on all sides by peritoneum, but recent evidence suggests that the posterior wall of the esophagus, adjacent to the diaphragm, is often devoid of peritoneal cover. The esophagus is covered in front by the left lobe of the liver.

Stomach

The stomach (ventriculus, s.gaster) can be divided into two large sections by an oblique line passing through the notch on the lesser curvature (incisura angularis) and the groove on the greater curvature, corresponding to the left border of the expansion of the stomach (see below). To the left of this line lies the larger section - the cardiac (occupies approximately 2/3 of the stomach), to the right - the smaller section - the pyloric. The cardiac section, in turn, consists of a body and a fundus, and the bottom, or vault, is the wide part of the stomach lying to the left of the cardia and upward from the horizontal line, drawn through the cardiac notch (incisura cardiaca). In the pyloric section, there is a left widened part - the vestibule (vestibulum pyloricum), otherwise - the sinus (sinus ventriculi), and a right narrow part - the antrum (antrum pyloricum), which passes into the duodenum.

The inlet and lesser curvature retain their position even with significant filling of the stomach, which is associated with the fixation of the final section of the esophagus in a special opening of the diaphragm; on the contrary, the pylorus and greater curvature can move quite significantly. The position of the organ also depends on the ligamentous apparatus, the position and functional state of neighboring organs and the elasticity of the abdominal muscles.

The stomach is located almost entirely in the left half of the abdominal cavity, with its larger part (cardia, fundus, part of the body) in the left hypochondrium (under the left dome of the diaphragm) and its smaller part (part of the body, pyloric region) in the epigastric region itself.

The greater curvature of a moderately filled stomach in a living person with the body in an upright position is located slightly above the level of the navel.

The anterior wall of the stomach on the right is covered by the liver, on the left by the costal part of the diaphragm: part of the body and pyloric part of the stomach adjoins directly to the anterior abdominal wall. Adjacent to the posterior wall of the stomach are organs separated from it by the omental bursa (pancreas, crura of the diaphragm, left adrenal gland, upper pole of the left kidney), as well as the spleen. The lesser curvature of the stomach is covered by the left lobe of the liver. The greater curvature borders the transverse colon.

The cardial part of the stomach and its fundus are connected to the diaphragm through lig.phrenicogastricum dextrum and sinistrum. The lig.hepatogastricum is stretched between the lesser curvature and the porta hepatis. The fundus of the stomach is connected to the spleen through the lig.gastrolienale. The greater curvature of the stomach is connected to the transverse colon through the initial section of the greater omentum (lig.gastrocolicum).

The blood supply to the stomach is carried out by the truncus coeliacus system (a.coeliaca - BNA). The stomach has two arterial arches: one along the lesser curvature, the other along the greater curvature. On the lesser curvature, aa.gastrica sinistra (from truncus coeliacus) and dextra (from a.hepatica), passing between the leaves of the lesser omentum, connect with each other. On the greater curvature, aa.gastroepicloica sinistra (from a.lienalis) and dextra (from a.gastroduodenalis) are anastomosed and often connected to each other.

Both arteries pass between the leaves of the greater omentum: the right one initially goes behind the upper part of the duodenum, and the left one - between the leaves of the lig.gastrolienale. In addition, several aa.gastricae breves go to the bottom of the stomach in the thickness of the lig.gastrolienale. The listed arteries give off branches that anastomose with each other and supply blood to all parts of the stomach.

Veins, like arteries, run along the lesser and greater curvature. Along the lesser curvature passes v.coronaria ventriculi, along the greater curvature - v.gastroepiploica dextra (influx of v.mesenterica superior) and v.gastroepiploica sinistra (influx of v.lienalis); both veins anastomose with each other. Vv.gastricae breves flow into v.lienalis.

Along the pylorus, almost parallel to the midline, runs the v.prepulorica, which quite accurately corresponds to the junction of the stomach with the duodenum and is usually a tributary of the right gastric vein.

Around the inlet of the stomach, its veins anastomose with the veins of the esophagus, and thus a connection is established between the portal and superior vena cava systems. If the outflow in the portal vein system is impaired, these anastomoses can dilate, which often leads to bleeding.

The innervation of the stomach is carried out by sympathetic and parasympathetic fibers. The first are part of the branches that extend from the solar plexus and accompany the vessels arising from the celiac artery. The vagus trunks, which produce parasympathetic fibers, branch on the anterior and posterior walls of the stomach: the anterior one on the anterior wall, the posterior one on the posterior wall. The most sensitive areas of the stomach to reflex influences are the pylorus and a significant part of the lesser curvature.

The regional nodes of the first stage for the efferent lymphatic vessels of the stomach are:

1) a chain of nodes located along the left gastric artery (receive lymph from the right two-thirds of the fundus and body of the stomach);

2) nodes in the area of the hilum of the spleen, tail and the part of the body of the pancreas closest to it (receive lymph from the left third of the fundus and body of the stomach to the middle of the greater curvature);

3) nodes located on the gastroepiploica dextra and under the pylorus (receive lymph from the territory of the stomach adjacent to the right half of the greater curvature).

The regional nodes of the second stage for most of the efferent lymphatic vessels of the stomach are the celiac nodes adjacent to the trunk of the celiac artery. Numerous connections are formed between the lymphatic vessels of the stomach and neighboring organs, which are of great importance in the pathology of the abdominal organs.

Esophagus- part of the gastrointestinal tract between the pharynx and stomach, which is a hollow tubular muscular canal, starting at the level of the lower edge of the VI cervical vertebra and ending with the transition to the cardiac part of the stomach at the level of the XI thoracic vertebra.

The wall of the esophagus consists of several layers, namely: the mucous membrane, submucosal layer, muscular layer and adventitia, sometimes the abdominal part of the esophagus is covered with a serous membrane. The muscular layer consists of two layers: the outer longitudinal and the inner circular.

In an adult, the length of the esophagus is on average 25 cm. It is customary to divide the esophagus into three sections: cervical, thoracic, abdominal (abdominal).

Cervical esophagus has a length of 5-6 cm, it begins at the level of the VII cervical vertebra behind the cricoid cartilage of the larynx and, located behind the trachea and in front of the spine, stretches to the level of the upper aperture of the chest. To the right and left of the esophagus are the lobes of the thyroid gland.

Thoracic esophagus has a length of 17-19 cm, is located in the posterior mediastinum, first between the trachea and the spine, and then between the heart and the thoracic part of the aorta, which pushes it slightly to the left.

Abdominal located at the level of the XI-XII thoracic vertebrae. Its length ranges from 2 to 4 cm. In the area of the esophagogastric junction (the transition to the cardiac part of the stomach), the lumen of the esophagus is normally closed and opens only when food passes.

Along the esophagus there are three narrowings of its lumen. The first narrowing is associated with the pressure of the cricoid cartilage and the inferior pharyngeal constrictor, the second is due to the pressure of the aortic arch, which presses the esophagus against the left main bronchus. This narrowing is located at the level of the IV thoracic vertebra. The third narrowing is located at the level of the esophageal opening of the diaphragm.

The blood supply to the esophagus in the cervical region is carried out by the branches of the inferior thyroid artery, in the thoracic region - by 4-5 esophageal branches of the thoracic aorta (their own esophageal arteries), in the lower section (abdominal) - by the ascending branch of the left gastric artery and the inferior phrenic artery. The outflow of blood from the esophagus is carried out into the azygos and semi-unpaired veins. The main collector of venous blood is the submucosal plexus.

The lymphatic system of the esophagus is represented by a network of capillaries and vessels, which are located in all layers of the esophageal wall: mucous membrane, submucosal layer, muscular layer, as well as in the adventitia.

A feature of the lymphatic system of the esophagus is the longitudinal, rather large lymphatic collector vessels located in the submucosal layer of the wall along the entire length of the esophagus, connecting the lymphatic networks of all its layers.

The efferent lymphatic vessels exit both on the anterior and posterior surfaces of the esophagus and have ascending, descending and transverse directions.

The topography of the regional lymph nodes of the esophagus is very important. From the cervical esophagus, the drainage vessels are directed to the deep cervical lower and paratracheal lymph nodes.

The deep cervical lower lymph nodes are located along the main vascular bundle of the neck on both sides, along the internal jugular vein. The efferent lymphatic vessels flow into the subclavian and jugular lymphatic trunks, into the thoracic lymphatic duct, and also directly into the subclavian and jugular veins.

Lymphatic vessels from the cervical and upper thoracic esophagus also flow into the paratracheal lymph nodes. They are located in a chain on both sides of the trachea in the groove between the esophagus and trachea, accompanying the recurrent nerves. The efferent lymphatic vessels from them go to the deep cervical lymph nodes, mediastinal, and can also flow into the jugular lymphatic trunks, the thoracic lymphatic duct, and the right lymphatic duct. The lowest of the group of right paratracheal lymph nodes is the lymph node of the arch of the azygos vein. It is located under the arch of the azygos vein. From it, lymph flows into the bronchopulmonary and tracheobronchial lymph nodes.

Lymph also flows from the upper parts of the esophagus into the upper and lower tracheobronchial lymph nodes. The superior tracheobronchial lymph nodes are located between the trachea and the main bronchus. Lymph also flows into them from the lower tracheobronchial and bronchopulmonary lymph nodes. The outflow of lymph through the efferent lymphatic vessels is carried out into the deep cervical lymph nodes, the thoracic lymphatic duct and the right lymphatic duct. The lower tracheobronchial (bifurcation) lymph nodes are located under the bifurcation of the trachea. They also receive lymph from the middle sections of the esophagus, as well as from the bronchopulmonary lymph nodes. The outflow of lymph occurs into the upper tracheobronchial, paratracheal, posteromedial lymph nodes, as well as directly into the thoracic lymphatic duct.

Bronchopulmonary lymph nodes are located along the main bronchus and its branches. Lymph flows into them from the nearest parts of the esophagus. Next, the lymph flows into the anterior mediastinal, upper and lower tracheobronchial lymph nodes, as well as into the thoracic lymphatic duct on the right and the lymphatic duct on the left.

From the middle parts of the esophagus, lymph also flows into the posteromedial lymph nodes, which are located near the esophagus in the posterior mediastinum. From them, lymph flows through drainage vessels into the tracheobronchial lymph nodes, which can also flow directly into the thoracic lymphatic duct.

The prevertebral lymph nodes are located along the anterior surface of the thoracic spine. They receive lymph from the thoracic esophagus. From them, the outflow of lymph occurs into the thoracic duct.

Lymph flows from the lower parts of the esophagus in two directions. Through short drainage vessels, it is sent to the lateral pericardial lymph nodes, located behind the pericardium at the point where the phrenic nerve enters the diaphragm, the upper phrenic lymph nodes, located above the diaphragm behind the xiphoid process of the sternum in the mediastinum, paraesophageal, bronchopulmonary and lower tracheobronchial lymph nodes. Through long drainage vessels that descend down into the abdominal cavity along the right and left vagus nerves, lymph flows into the chain of left gastric lymph nodes located near the lesser curvature of the stomach along the left gastric artery and paracardial lymph nodes located in the tissue near the esophagogastric junction in the abdominal cavity. The lowest of the group of left gastric lymph nodes are the lymph nodes in the region of the fork of the celiac trunk.

It is necessary to note two features of the lymphatic system of the esophagus.

First- large lymphatic collectors are located longitudinally along the entire esophagus in the submucosal layer.

Second- often the draining lymphatic vessels, bypassing the regional lymph nodes, flow into the left gastric or paracardial lymph nodes, or - directly into the thoracic lymphatic duct.

The thoracic lymphatic duct begins in the retroperitoneal space in the form of a cistern located at the level of the I lumbar -XII thoracic vertebrae, passes along the right wall of the aorta into the chest cavity, into the posterior mediastinum, located between the aorta and the azygos vein. Above, the thoracic duct is located in the midline on the prevertebral fascia to the left of the aorta and is partially covered by the esophagus. Rising above the thoracic duct, being further connected with the esophagus, it passes to the neck and forms an arch at this level. The latter goes around the dome of the pleura from back to front and flows into the left venous angle. At the junction of the thoracic lymphatic duct there are a large number of lymph nodes. Often the thoracic duct is represented not by one, but by several trunks.

Most often, during resection of the thoracic esophagus, the surgeon is forced to contact the thoracic duct, which is associated with the risk of injury to both the main trunk and the branches flowing into it. This requires ligation of the duct above and below the wound site.

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Esophagus, is a narrow and long active tube inserted between the pharynx and stomach and helps move food into the stomach. It begins at the level of the VI cervical vertebra, which corresponds to the lower edge of the cricoid cartilage of the larynx, and ends at the level of the XI thoracic vertebra.

Since the esophagus, starting in the neck, passes further into the chest cavity and, perforating the diaphragm, enters the abdominal cavity, parts are distinguished in it. The length of the esophagus is 23-25 cm. The total length of the path from the front teeth, including the oral cavity, pharynx and esophagus, is 40-42 cm (at this distance from the teeth, adding 3.5 cm, a gastric rubber probe must be advanced into the esophagus to take gastric juice for examination).

Topography of the esophagus. The cervical part of the esophagus is projected from the VI cervical to the II thoracic vertebra. The trachea lies in front of it, the recurrent nerves and common carotid arteries pass to the side.

The syntopy of the thoracic part of the esophagus is different at different levels: the upper third of the thoracic esophagus lies behind and to the left of the trachea, the left recurrent nerve and left a are adjacent to it in front, the spinal column is behind it, and the mediastinal pleura is on the right. In the middle third, the aortic arch is adjacent to the esophagus in front and to the left at the level of the IV thoracic vertebra, slightly lower (V thoracic vertebra) - the bifurcation of the trachea and the left bronchus; behind the esophagus lies the thoracic duct; to the left and somewhat posteriorly the descending part of the aorta adjoins the esophagus, to the right - the right vagus nerve, to the right and posteriorly. In the lower third of the thoracic esophagus, behind and to the right of it lies the aorta, in front - the pericardium and the left vagus nerve, on the right - the right vagus nerve, which is shifted below to the posterior surface; lies somewhat behind; on the left - the left mediastinal pleura.

The abdominal part of the esophagus is covered with peritoneum in front and on the sides; the left lobe of the liver is adjacent to it in front and to the right, the upper pole of the spleen is to the left, and a group of lymph nodes is located at the junction of the esophagus and the stomach.

Structure. On a cross-section, the lumen of the esophagus appears as a transverse slit in the cervical part (due to pressure from the trachea), while in the thoracic part the lumen has a round or stellate shape.

The wall of the esophagus consists of the following layers: the innermost layer is the mucous membrane, the middle and outer layers are of a connective tissue nature and contain mucous glands that facilitate the sliding of food with their secretions when swallowing. In addition to the mucous glands, small glands similar in structure to the cardiac glands of the stomach are also found in the lower and, less commonly, upper sections of the esophagus. When not stretched, the mucous membrane gathers into longitudinal folds. Longitudinal folding is a functional adaptation of the esophagus, facilitating the movement of fluids along the esophagus along the grooves between the folds and stretching the esophagus during the passage of dense lumps of food. This is facilitated by the looseness, thanks to which the mucous membrane acquires greater mobility, and its folds easily appear and then smooth out. The layer of unstriated fibers of the mucous membrane itself also participates in the formation of these folds.

In the submucosa there are lymphatic follicles, corresponding to the tubular shape of the esophagus, which, when performing its function of carrying food, must expand and contract, is located in two layers - the outer, longitudinal (dilating esophagus), and the internal, circular (constricting). In the upper third of the esophagus, both layers are composed of striated fibers; below they are gradually replaced by non-striated myocytes, so that the muscle layers of the lower half of the esophagus consist almost exclusively of involuntary muscles.

Surrounding the outside of the esophagus, it consists of loose connective tissue, through which the esophagus is connected to the surrounding organs. The looseness of this membrane allows the esophagus to change the size of its transverse diameter as food passes through.

X-ray examination of the digestive tube is carried out using the method of creating artificial contrasts, since without the use of contrast media it is not visible. For this, the subject is given a “contrast food” - a suspension of a substance with a high atomic mass, preferably insoluble barium sulfate. This contrast food blocks x-rays and produces a shadow on the film or screen that corresponds to the cavity of the organ filled with it. By observing the movement of such contrasting food masses using fluoroscopy or radiography, it is possible to study the x-ray picture of the entire digestive canal. When the stomach and intestines are completely or, as they say, “tightly” filled with a contrasting mass, the X-ray picture of these organs has the character of a silhouette or, as it were, a cast of them; with a small filling, the contrast mass is distributed between the folds of the mucous membrane and gives an image of its relief.

X-ray anatomy of the esophagus. The esophagus is examined in oblique positions - in the right nipple or left scapular. During an X-ray examination, the esophagus containing a contrasting mass has the appearance of an intense longitudinal shadow, clearly visible against the light background of the pulmonary field located between the heart and the spinal column. This shadow is like a silhouette of the esophagus. If the bulk of the contrast food passes into the stomach, and swallowed air remains in the esophagus, then in these cases one can see the contours of the walls of the esophagus, clearing at the site of its cavity and the relief of the longitudinal folds of the mucous membrane. Based on X-ray data, it can be noted that the esophagus of a living person differs from the esophagus of a corpse in a number of features due to the presence of intravital muscle tone in a living person. This primarily concerns the position of the esophagus. On a corpse it forms bends: in the cervical part the esophagus first runs along the midline, then slightly deviates from it to the left; at the level of the V thoracic vertebra it returns to the midline, and below it again deviates to the left and forward to the diaphragm. In a living person, the bends of the esophagus in the cervical and thoracic regions are less pronounced.

The lumen of the esophagus has a number of narrowings and expansions that are important in the diagnosis of pathological processes:

pharyngeal (at the beginning of the esophagus),
bronchial (at the level of tracheal bifurcation)
diaphragmatic (when the esophagus passes through the diaphragm).

These are anatomical narrowings that remain on the corpse. But there are two more narrowings - aortic (at the beginning of the aorta) and cardiac (at the transition of the esophagus to the stomach), which are expressed only in a living person. Above and below the diaphragmatic constriction there are two expansions. The inferior expansion can be considered as a kind of vestibule of the stomach. Fluoroscopy of the esophagus of a living person and serial photographs taken at intervals of 0.5-1 s allow one to study the act of swallowing and peristalsis of the esophagus.

Endoscopy of the esophagus. During esophagoscopy (i.e., when examining the esophagus of a sick person using a special device - an esophagoscope), the mucous membrane is smooth, velvety, and moist. Longitudinal folds are soft and plastic. Along them there are longitudinal vessels with branches.

The esophagus is fed from several sources, and the arteries that feed it form abundant anastomoses of the esophagus and originate from several branches. Venous outflow from the cervical part of the esophagus occurs from the thoracic region, from the abdominal - into the tributaries of the portal vein. From the cervical and upper third of the thoracic esophagus, lymphatic vessels go to the deep cervical nodes, pretracheal and paratracheal, tracheobronchial and posterior mediastinal nodes. From the middle third of the thoracic region, the ascending vessels reach the named nodes of the chest and neck, and the descending vessels reach the nodes of the abdominal cavity: gastric, pyloric and pancreaticoduodenal. Vessels coming from the rest of the esophagus (supradiaphragmatic and abdominal sections) flow into these nodes.

The esophagus is innervated. The feeling of pain is transmitted through the branches; sympathetic innervation reduces esophageal peristalsis. Parasympathetic innervation enhances peristalsis and gland secretion.

Doctors to examine the Esophagus:

Gastroenetrologist

Diseases associated with the Esophagus:

Benign tumors and cysts of the esophagus

Esophageal sarcoma

Esophageal carcinoma

Congenital anomalies of the esophagus

Damage to the esophagus

Foreign bodies of the esophagus

Chemical burns and cicatricial narrowing of the esophagus

Achalasia of the cardia (cardiospasm) of the esophagus

Chalazia (insufficiency) of the esophageal cardia

Reflux esophagitis (peptic esophagitis)

Esophageal diverticula

Esophageal ulcer

What tests and diagnostics need to be done for the Esophagus:

Methods for studying the esophagus

X-ray of the esophagus

CT scan of the esophagus

MRI of the esophagus

The esophagus is one of the most important organs of the digestive system; it is a natural continuation of the pharynx, connecting it with the stomach. It is a smooth, stretchable fibromuscular mucous tube, flattened in the anteroposterior direction. The esophagus begins behind the cricoid cartilage at its lower edge, which corresponds to the level of the VI-VII cervical vertebrae and ends at the cardia of the stomach at the level of the XI thoracic vertebra. The length of the esophagus depends on age, gender and constitution, averaging 23 - 25 cm in an adult.

For most of its course, the esophagus is located posterior to the trachea and anterior to the spine in the deep cervical and thoracic mediastinum. Behind the esophagus, between the fourth layer of fascia, which envelops the esophagus, and the fifth layer (prevertebral fascia), there is a retrovisceral space filled with loose fiber.

This space, which allows the esophagus to expand freely as food passes, is clinically very important because is a natural way of rapid spread of infection when the esophagus is damaged.

In its course, the esophagus deviates from a straight line, bending around the aorta in the form of a gentle spiral. On the neck, located behind the trachea, it protrudes from behind it somewhat to the left and in this place is most accessible for surgical intervention. At the border of the IV and V thoracic vertebrae, the esophagus intersects with the left bronchus, passing behind it, then deviates slightly to the right and, before perforating the diaphragm, again lies to the left of the median plane. In this place, the thoracic aorta is located significantly to the right and posterior to it.

There are three sections in the esophagus: cervical, thoracic and abdominal (Fig. 5.1). The border between the cervical and thoracic sections of the esophagus passes at the level of the jugular notch of the sternum in front and the space between the VII cervical and I thoracic vertebrae posteriorly. The thoracic, the longest section of the esophagus, has the diaphragm as its lower border, and the abdominal is located between the diaphragm and the cardia of the stomach. The length of individual parts of the esophagus in adults is: cervical - 4.5-5 cm, thoracic - 16-17 cm, abdominal - 1.5-4.5 cm.

There are three anatomical and two physiological narrowings in the esophagus (Tonkov V.N., 1953). However, from a clinical point of view, the three most pronounced narrowings are important, the origin of which is associated with a number of anatomical formations, as well as the distance to these narrowings, which are favorite places for the retention of foreign bodies, from the edge of the upper incisors (Fig. 5.2).

The first, most important for clinical practice, narrowing corresponds to the beginning of the esophagus. It is due to the presence of a powerful muscle sphincter that performs the function of a sphincter. One of the first esophagoscopists, Killian, called it “the mouth of the esophagus.” The first narrowing is located at a distance of 15 cm from the edge of the upper incisors. The origin of the second narrowing is associated with pressure on the esophagus of the left main bronchus, located in front, and the aorta, lying to the left and behind. It is located at the level of the bifurcation of the trachea and the IV thoracic vertebra. The distance from the edge of the upper incisors to the second narrowing is 23-25 cm. The third narrowing of the esophagus is located at a distance of 38-40 cm from the edge of the incisors and is caused by the passage of the esophagus through the diaphragm and into the stomach (gastroesophageal junction).

The listed narrowings of the esophagus, especially the first one, which make it difficult to pass the esophagoscope tube and other endoscopic instruments, can be the site of their instrumental damage.

In the cervical and abdominal sections, the lumen of the esophagus is in a collapsed state, and in the thoracic section it gapes due to negative pressure in the chest cavity.

The wall of the esophagus, which is about 4 mm thick, has three layers. The muscle layer is formed by external longitudinal and internal circular fibers. In the upper parts of the esophagus, the muscle layer is similar to the muscle layer of the pharynx, and is a continuation of its striated muscle fibers. In the middle section of the esophagus, striated fibers are gradually replaced by smooth ones, and in the lower section the muscle layer is represented only by smooth fibers. Morphological studies by F.F. Saksa et al. (1987) showed that the inner ends of the longitudinal muscle fibers of the outer layer go deep into the wall, where they, as if wrapping the esophagus, form a circular layer. As a result of the combination of circular and longitudinal muscles in the area of the transition of the esophagus to the stomach, the sphincter of the cardia is formed.

The submucosal layer is represented by well-developed loose connective tissue, in which numerous mucous glands are located. The mucous membrane is covered with multilayered (20 - 25 layers) squamous epithelium. Thanks to the pronounced submucosal layer, loosely connected with the muscular layer, the mucous membrane of the esophagus can gather in folds, giving it a star-shaped appearance on cross sections.

As food passes through the endoscope (esophagoscope), the folds straighten out. The absence of folds in a particular area of the esophagus may indicate the presence of a pathological process (tumor) in the wall.

Outside, the esophagus is surrounded by adventitia, which consists of loose fibrous connective tissue enveloping the muscular layer of the esophagus. Some authors consider it as the fourth (adventitial) layer of the esophagus. The adventitia, without clear boundaries, passes into the mediastinal tissue.

Blood supply. The blood supply to the esophagus comes from several sources. In this case, all esophageal arteries form numerous anastomoses among themselves. In the cervical region, the esophageal arteries are branches of the inferior thyroid artery, in the thoracic region - branches arising directly from the thoracic aorta, in the abdominal region - from the phrenic and left gastric arteries. The esophageal veins drain blood: from the cervical region into the lower thyroid veins, from the thoracic region - into the azygos and semi-gypsy veins, from the abdominal - into the coronary vein of the stomach, which communicates with the portal vein system. Compared to other parts of the gastrointestinal tract, the esophagus is distinguished by a very developed venous plexus, which, in some pathological conditions (portal hypertension), is a source of massive and dangerous bleeding.

Lymphatic system. The lymphatic system of the esophagus is represented by a superficial and deep network. The superficial network originates in the thickness of the muscle wall, and the deep one is located in the mucous membrane and submucosal layer. The outflow of lymph in the cervical esophagus goes to the upper paratracheal and deep cervical nodes. In the thoracic and abdominal sections, lymph is sent to the lymph nodes of the cardial part of the stomach, as well as to the paratracheal and parabronchial nodes (Zhdanov D.A., 1948).

Innervation of the esophagus. The esophagus is innervated by the branches of the vagus and sympathetic nerves. The main motor nerves of the esophagus are considered to be parasympathetic branches emanating from both sides of the vagus nerves. At the level of the tracheal bifurcation, the vagus nerves form the anterior and posterior periesophageal plexuses, which are connected by numerous branches to other plexuses of the chest organs, especially the heart and lungs.

Sympathetic innervation of the esophagus is provided by branches from the cervical and thoracic nodes of the border trunks, as well as by the splanchnic nerves. There are numerous anastomoses between the branches of the sympathetic and parasympathetic nerves innervating the esophagus.

In the nervous apparatus of the esophagus, three closely interconnected plexuses are distinguished: superficial (adventitial), intermuscular (Auerbach), located between the longitudinal and circular muscle layers, and submucosal (Meissner).

The mucous membrane of the esophagus has thermal, pain and tactile sensitivity. All this indicates that the esophagus is a well-developed reflexogenic zone.

The esophagus is a hollow muscular tube lined with mucous membrane on the inside that connects the pharynx to the stomach.
Its length is on average 25-30 cm in men and 23-24 cm in women
It begins at the lower edge of the cricoid cartilage, which corresponds to C VI, and ends at the level of Th XI with a transition to the cardiac part of the stomach
The wall of the esophagus consists of three membranes: mucous membrane (tunica mucosa), muscular membrane (tunica muscularis), connective tissue membrane (tunica adventicia)
The abdominal part of the esophagus is covered on the outside with a serous membrane, which is a visceral layer of the peritoneum.
Along its course, it is fixed to the surrounding organs by connecting cords containing muscle fibers and blood vessels. Has several bends in the sagittal and frontal planes

cervical - from the lower edge of the cricoid cartilage at level C VI to the jugular notch at level Th I-II. Its length is 5-6 cm;
thoracic section from the jugular notch to the place where the esophagus passes through the esophageal opening of the diaphragm at the level of Th X—XI, its length is 15—18 cm;
abdominal section from the esophageal opening of the diaphragm to the junction of the esophagus and the stomach. Its length is 1-3 cm.

According to the classification of Brombart (1956), there are 9 segments of the esophagus:

tracheal (8-9 cm);
retropericardial (3 - 4 cm);
aortic (2.5 - 3 cm);
supradiaphragmatic (3 - 4 cm);
bronchial (1 - 1.5 cm);
intradiaphragmatic (1.5 - 2 cm);
aortic-bronchial (1 - 1.5 cm);
abdominal (2 - 4 cm).
subbronchial (4 - 5 cm);

Anatomical narrowing of the esophagus:

Pharyngeal - in the area of the transition of the pharynx to the esophagus at the level of VI-VII cervical vertebrae
Bronchial - in the area of contact of the esophagus with the posterior surface of the left bronchus at the level of IV-V thoracic vertebrae
Diaphragmatic - where the esophagus passes through the diaphragm

Physiological narrowing of the esophagus:

Aortic - in the area where the esophagus is adjacent to the aortic arch at the level of Th IV
Cardiac - at the transition of the esophagus to the cardiac part of the stomach

An endoscopic sign of the esophageal-gastric junction is the Z-line, which is normally located at the level of the esophageal opening of the diaphragm. The Z-line represents the place of transition of the esophageal epithelium into the gastric epithelium. The esophageal mucosa is covered with stratified squamous epithelium, the gastric mucosa is covered with single-layer columnar epithelium.

The figure shows an endoscopic pictureZ-lines

The blood supply to the esophagus in the cervical region is carried out by the branches of the inferior thyroid arteries, the left superior thyroid artery, and the subclavian arteries. The upper thoracic region is supplied with blood by the branches of the inferior thyroid artery, subclavian arteries, the right thyrocervical trunk, the right vertebral artery, and the right intrathoracic artery. The midthoracic region is supplied by the bronchial arteries, esophageal branches of the thoracic aorta, and the 1st and 2nd intercostal arteries. The blood supply to the lower thoracic region is provided by the esophageal branches of the thoracic aorta, the esophageal aorta, which extends from the aorta (Th7-Th9), and the branches of the right intercostal arteries. The abdominal esophagus is supplied by the esophageal cardial branches of the left gastric, esophageal (from the thoracic aorta), and left lower diaphragmatic branches.

The esophagus has 2 venous plexuses: central in the submucosal layer and superficial paraesophageal. The outflow of blood from the cervical esophagus occurs through the lower thyroid, bronchial, 1-2 intercostal veins into the innominate and superior vena cava. The outflow of blood from the thoracic region occurs through the esophageal and intercostal branches into the azygos and semipaired veins, then into the superior vena cava. From the lower third of the esophagus - through the branches of the left gastric vein, the upper branches of the splenic vein into the portal vein. Part from the left inferior phrenic vein to the inferior vena cava.

Rice. Venous system of the esophagus

Lymphatic drainage from the cervical esophagus is carried out into the paratracheal and deep cervical lymph nodes. From the upper thoracic region - to the paratracheal, deep cervical, tracheobronchial, paravertebral, bifurcation. The outflow of lymph from the midthoracic esophagus is carried out to the bifurcation, tracheobronchial, posterior mediastinal, interaortoesophageal and paravertebral ml/s. From the lower third of the esophagus - to the pericardial, upper diaphragmatic, left gastric, gastropancreatic, celiac and hepatic l/u.

Rice. Lymph nodes of the esophagus

The sources of innervation of the esophagus are the vagus nerves and the border trunks of the sympathetic nerves; the main role belongs to the parasympathetic nervous system. Preganglionic neurons of the efferent branches of the vagus nerves are located in the dorsal motor nuclei of the brainstem. Efferent fibers form the anterior and posterior esophageal plexuses and penetrate the wall of the organ, connecting with the intramural ganglia. Between the longitudinal and circular muscular layers of the esophagus, the Auerbach plexus is formed, and in the submucosal layer, the Meissner nerve plexus is formed, in the ganglia of which peripheral (postganglionic) neurons are located. They have a certain autonomous function, and a short neural arc can close at their level. The cervical and upper thoracic sections of the esophagus are innervated by branches of the recurrent nerves, forming powerful plexuses that also innervate the heart and trachea. In the midthoracic esophagus, the anterior and posterior nerve plexuses also include branches of the borderline sympathetic trunk and large splanchnic nerves. In the lower thoracic section of the esophagus, trunks are formed again from the plexuses - the right (posterior) and left (anterior) vagus nerves. In the supraphrenic segment of the esophagus, the vagal trunks are closely adjacent to the wall of the esophagus and, having a spiral course, branch: the left one is on the anterior surface, and the right one is on the posterior surface of the stomach. The parasympathetic nervous system regulates the motor function of the esophagus reflexively. Afferent nerve fibers from the esophagus enter the spinal cord at the level of Thv-viii. The role of the sympathetic nervous system in the physiology of the esophagus has not been fully elucidated. The mucous membrane of the esophagus has thermal, pain and tactile sensitivity, with the most sensitive areas being the pharyngoesophageal and esophagogastric junction.

Rice. Innervation of the esophagus

Rice. Diagram of the internal nerves of the esophagus

The functions of the esophagus include: motor-evacuation, secretory, obturator. The function of the cardia is regulated by the central pathway (pharyngeal-cardiac reflex), autonomous centers located in the cardia itself and the distal esophagus, as well as through a complex humoral mechanism, which involves numerous gastrointestinal hormones (gastrin, cholecystokinin-pancreozymin, somatostatin, etc. ) Normally, the lower esophageal sphincter is usually in a state of constant contraction. Swallowing causes a peristaltic wave, which leads to a short-term relaxation of the lower esophageal sphincter. Signals that initiate esophageal peristalsis are generated in the dorsal motor nuclei of the vagus nerve, then conducted through the long preganglionic neurons of the vagus nerve to short postganglionic inhibitory neurons located in the region of the lower esophageal sphincter. Inhibitory neurons, when stimulated, release vasoactive intestinal peptide (VIP) and/or nitrous oxide nitrogen, which cause relaxation of the smooth muscles of the lower esophageal sphincter using intracellular mechanisms involving cyclic adenosine monophosphate.

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