Patti M G, Fisichella P M
University of Chicago, Pritzker School of Medicine, Department of Surgery, Chicago, Illinois, USA.
G Chir. 2009 Nov-Dec;30(11-12):472-5.
The last decade has witnessed radical changes in the treatment of esophageal achalasia due to the development of minimally invasive techniques. Because of the high success rate of the laparoscopic Heller myotomy, a radical shift in the treatment algorithm of these patients has occurred, and today this is the preferred treatment modality for achalasia. This remarkable change is due to the recognition by gastroenterologists and patients that a laparoscopic Heller myotomy outperforms pneumatic dilatation and intra-sphincteric injection of botulinum toxin injection. While there is agreement about the technique of the myotomy per se, some questions still linger about the need for a fundoplication after the myotomy. The following review describes the data present in the literature in order to identify the best procedure that can achieve relief of dysphagia while avoiding development of gastroesophageal reflux.
过去十年间，由于微创技术的发展，食管贲门失弛缓症的治疗发生了根本性变化。鉴于腹腔镜下Heller肌切开术的高成功率，这些患者的治疗方案已发生了根本性转变，如今这已成为贲门失弛缓症的首选治疗方式。这一显著变化是因为胃肠病学家和患者认识到，腹腔镜下Heller肌切开术优于气囊扩张术和括约肌内注射肉毒杆菌毒素。虽然对于肌切开术本身的技术已达成共识，但肌切开术后是否需要行胃底折叠术仍存在一些问题。以下综述介绍了文献中的数据，以确定能够缓解吞咽困难同时避免发生胃食管反流的最佳手术方法。
