Division of Surgery, Oregon Health Sciences University, Portland, OR, USA.
IHU-Strasbourg, Strasbourg, France.
Korean J Intern Med. 2019 Nov;34(6):1173-1180. doi: 10.3904/kjim.2018.439. Epub 2019 Mar 15.
Achalasia was first described in the 17th century and its treatment continues to be challenging. Palliative treatment involves disruption of the lower esophageal sphincter, which can be accomplished mechanically (balloon dilation or surgical myotomy) or chemically (Botox). True surgical treatment originated some 100 years ago and remained largely unchanged until the advent of thoracoscopic and then laparoscopic myotomy beginning in the 1980s. Because these procedures provided relatively definitive treatment and were well tolerated by patients, minimal invasive surgery assumed a primary role in the treatment algorithms for achalasia. In 2008, an endoscopic (incision-less) myotomy approach, per-oral endoscopic myotomy, was described. This even less invasive approach has rapidly been adopted in the majority of high-volume achalasia centers. Newer interventions, such as stenting and cell transplant, are under active investigation.
贲门失弛缓症于 17 世纪首次被描述，其治疗仍然具有挑战性。姑息性治疗包括破坏食管下括约肌，可通过机械手段（球囊扩张或手术肌切开术）或化学手段（肉毒杆菌毒素）来实现。真正的手术治疗起源于大约 100 年前，直到 20 世纪 80 年代开始出现胸腔镜和腹腔镜肌切开术，这种治疗方法才基本保持不变。由于这些手术提供了相对确定性的治疗效果，且患者耐受性良好，微创外科在贲门失弛缓症的治疗方案中占据了主要地位。2008 年，一种内镜（无切口）肌切开术方法，经口内镜肌切开术，被描述出来。这种微创程度更高的方法已在大多数大容量贲门失弛缓症中心迅速被采用。一些新的干预手段，如支架和细胞移植，也正在积极研究中。
