Almansa Cristina, Hinder Ronald A, Smith C Daniel, Achem Sami R
Division of Gastroenterology and Hepatology, Mayo Clinic, 4500 San Pablo Road, Jacksonville, FL 32224, USA.
J Gastrointest Surg. 2008 Jun;12(6):1133-45. doi: 10.1007/s11605-007-0439-x. Epub 2007 Dec 11.
Diffuse esophageal spasm is a motility disorder of undetermined cause. The optimal treatment remains controversial, and evidence-based data are lacking. Several medical treatment modalities have been proposed, but none has emerged as the treatment of choice. Patients who do not respond to medical therapy may be considered for surgical treatment. The surgical treatment of diffuse esophageal spasm is based on similar principles to the treatment of achalasia. A long esophageal myotomy is done to divide the hypertrophied circular muscle that is frequently noted in diffuse esophageal spasm. To protect against postoperative reflux, an antireflux procedure may be added. However, the surgical treatment of diffuse esophageal spasm has not been subjected to randomized clinical trials. The purpose of this article is to provide a review of the available literature regarding the surgical management of the diffuse esophageal spasm. In particular, we offer an appraisal of surgical outcomes, the effects of surgery on manometric and radiologic parameters (when available), complications, and mortality.
弥漫性食管痉挛是一种病因不明的动力障碍性疾病。最佳治疗方法仍存在争议，且缺乏循证数据。已提出多种药物治疗方式，但尚无一种成为首选治疗方法。对药物治疗无反应的患者可考虑手术治疗。弥漫性食管痉挛的手术治疗基于与贲门失弛缓症治疗相似的原则。进行长段食管肌切开术以切开弥漫性食管痉挛中常见的肥厚环形肌。为预防术后反流，可加做抗反流手术。然而，弥漫性食管痉挛的手术治疗尚未经过随机临床试验。本文旨在对有关弥漫性食管痉挛手术治疗的现有文献进行综述。特别是，我们对手术结果、手术对测压和放射学参数（如可用）的影响、并发症及死亡率进行评估。
