Brindley G C
Am Surg. 1975 Feb;41(2):94-6.
An obstructing lesion of the lower thoracic esophagus should be evaluated carefully and appropriate surgical therapy planned to correct the abnormal physiology. Gastroesophageal reflux is the most frequent cause of esophageal stricture and usually can be managed effectively by dilatation of the esophagus, restoration of a competent lower esophageal sphincter, and repair of an associated hiatal hernia. Collis gastroplasty and a Belsey herniorrhaphy are useful when the esophagus is excessively shortened. Firm, fixed esophageal strictures may be treated by the Thal procedure accompanied by Nissen's fundoplication or by resection of the stricture and interposition of a colon graft or an achlorhydric tube. The management of other benign strictures secondary to scleroderma, ingestion of caustic substances, or benign neoplasms must be individualized. Most benign strictures may be cared for by dilatation; however, firm, fixed strictures should be resected. Wide surgical resection is indicated for primary malignant lesions of the lower thoracic esophagus that are localized or have limited lymph node metastasis.
下胸段食管梗阻性病变应仔细评估，并制定适当的手术治疗方案以纠正异常生理状况。胃食管反流是食管狭窄最常见的原因，通常可通过食管扩张、恢复有效的下食管括约肌功能以及修复相关的食管裂孔疝来有效处理。当食管过度缩短时，科利斯胃成形术和贝尔西疝修补术是有用的。坚硬、固定的食管狭窄可通过塔尔手术联合尼森胃底折叠术治疗，或通过切除狭窄并植入结肠移植物或无胃酸管治疗。继发于硬皮病、腐蚀性物质摄入或良性肿瘤的其他良性狭窄的处理必须个体化。大多数良性狭窄可通过扩张治疗；然而，坚硬、固定的狭窄应行切除术。对于局限或仅有有限淋巴结转移的下胸段食管原发性恶性病变，应行广泛手术切除。
