Division of Thoracic Surgery, Department of Surgery, The Johns Hopkins Medical Institutions, Baltimore, Maryland 21287, USA.
Semin Thorac Cardiovasc Surg. 2012 Spring;24(1):19-26. doi: 10.1053/j.semtcvs.2012.01.015.
Esophageal achalasia is a chronic and progressive motility disorder that leads to massive esophageal dilation when left untreated. Treatment for achalasia is palliative and aimed to relieve the outflow obstruction at the level of the lower esophageal sphincter, yet protecting the esophageal mucosa from refluxing gastric acids. The best way to accomplish this goal is through an esophageal myotomy and partial fundoplication, with a success rate >90%. Progression of disease, treatment failure, and complications from gastroesophageal reflux disease cause progressive deterioration of the esophageal function to an end stage in about 5% of patients. The only chance to improve symptoms in this small group of patients is through an esophageal resection. This article will review the indications for esophagectomy in end-stage achalasia, present the different types of surgical approach and possibilities for reconstruction of the alimentary tract, and summarize the short-term and long-term postoperative results.
食管失弛缓症是一种慢性进行性运动障碍，如果不治疗，会导致食管严重扩张。失弛缓症的治疗是姑息性的，旨在缓解食管下括约肌水平的流出梗阻，同时保护食管黏膜免受反流胃酸的侵害。实现这一目标的最佳方法是通过食管肌切开术和部分胃底折叠术，成功率>90%。疾病的进展、治疗失败和胃食管反流病的并发症导致约 5%的患者食管功能逐渐恶化至终末期。在这一小部分患者中，改善症状的唯一机会是通过食管切除术。本文将回顾终末期失弛缓症行食管切除术的适应证，介绍不同类型的手术入路和消化道重建的可能性，并总结短期和长期术后结果。
