Woodward E R
Mayo Clin Proc. 1975 Sep;50(9):523-8.
The past two decades have seen outstanding contributions to our knowledge of the physiology of the esophagus, particularly of the lower esophageal sphincter. The clinical syndrome of reflux peptic esophagitis has been clearly delineated and is now well recognized. Although the relationship of the lower esophageal sphincter failure, which causes sliding esophageal hiatal hernia, remains obscure, successful hiatal herniorrhaphy by a variety of methods produces satisfactory clinical results in a majority of patients. There is a significant failure rate in all methods and a morbidity clearly related to operative intervention. Additive surgery such as vagotomy and pyloroplasty is not useful in preventing recurrence and is associated with increased morbidity. Peptic strictures with firm, fibrous stenosis can be satisfactorily treated in most cases with the Thal fundic patch to widen the lumen and Nissen fundoplication to prevent further gastroesophageal reflux.
在过去的二十年里，人们对食管生理学，尤其是食管下括约肌的生理学知识有了杰出的贡献。反流性消化性食管炎的临床综合征已被明确界定，现在已得到广泛认可。尽管导致滑动性食管裂孔疝的食管下括约肌功能障碍之间的关系仍不清楚，但通过各种方法成功进行裂孔疝修补术在大多数患者中产生了令人满意的临床效果。所有方法都有显著的失败率，且发病率与手术干预明显相关。诸如迷走神经切断术和幽门成形术等附加手术在预防复发方面并无用处，且会增加发病率。大多数情况下，对于伴有坚硬纤维性狭窄的消化性狭窄，采用塔尔胃底补片扩大管腔和nissen胃底折叠术预防进一步的胃食管反流，可得到满意的治疗效果。
