Ozawa Soji
Department of Surgery, Fujita Health University, 2nd Teaching Hospital, Nagoya, Japan.
Kyobu Geka. 2006 Jul;59(8 Suppl):781-9.
Gastroesophageal reflux disease (GERD) and esophageal achalasia are common benign esophageal diseases. Today minimally invasive surgery is recommended to treat these diseases. Surgical indications for GERD are failure of medical management, medical complications attributable to a large hiatal hernia, 'atypical' symptoms (asthma, hoarseness, cough, chest pain, aspiration), etc. according to the Society of American Gastrointestinal Endoscopic Surgeons (SAGES) guidelines. Laparoscopic Nissen fundoplication has emerged as the most widely accepted procedure for GERD patients with normal esophageal motility. Partial fundoplication (e.g., Toupet fundoplication) is also considered to decrease the possibility of postoperative dysphagia. Although pneumatic dilatation has been the first line treatment for esophageal achalasia, laparoscopic Heller myotomy and partial fundoplication (e.g., Dor fundoplication) to prevent reflux is preferred by most gastroenterologists and surgeons as the primary treatment modality. Laparoscopic surgery for GERD and esophageal achalasia are effective in most patients and safe in all patients. Finally, laparoscopic surgery should be performed only by skilled surgeons.
胃食管反流病(GERD)和食管贲门失弛缓症是常见的食管良性疾病。如今,推荐采用微创手术来治疗这些疾病。根据美国胃肠内镜外科医师协会(SAGES)的指南,GERD的手术指征包括药物治疗失败、因巨大食管裂孔疝导致的药物并发症、“非典型”症状(哮喘、声音嘶哑、咳嗽、胸痛、误吸)等。对于食管动力正常的GERD患者,腹腔镜下Nissen胃底折叠术已成为最广泛接受的术式。部分胃底折叠术(如Toupet胃底折叠术)也被认为可降低术后吞咽困难的可能性。尽管气囊扩张术一直是食管贲门失弛缓症的一线治疗方法,但大多数胃肠病学家和外科医生更倾向于采用腹腔镜Heller肌切开术和部分胃底折叠术(如Dor胃底折叠术)来预防反流,作为主要的治疗方式。GERD和食管贲门失弛缓症的腹腔镜手术对大多数患者有效,对所有患者都安全。最后,腹腔镜手术应由技术熟练的外科医生进行。