Patti Marco G, Schlottmann Francisco, Herbella Fernando A
Department of Medicine and Surgery, University of North Carolina, Chapel Hill, North Carolina.
Department of Surgery, Hospital Alemán of Buenos Aires, Buenos Aires, Argentina.
J Laparoendosc Adv Surg Tech A. 2020 Mar;30(3):233-235. doi: 10.1089/lap.2019.0718. Epub 2020 Jan 2.
Innovation is of critical importance for the progress of medicine in general, and of surgery in particular. The introduction of minimally invasive surgery 30 years ago determined a revolution in the way we treat surgical diseases today, as most operations are now performed avoiding large incisions, with a consequent decrease in postoperative pain, shorter hospital stay, and a faster return to daily activities. However, for any innovation to become standard of care, the following criteria must be met: (1) Is it feasible? (2) Is it safe? (3) Does it offer clinical advantages to patients and the health care system? The treatment of esophageal achalasia represents an example of an innovation-per oral endoscopic myotomy-that although feasible and safe has become the standard of care without clear proof that it improves patients' outcome and provides an advantage for the health care system. The review of the treatment of esophageal achalasia during the past 30 years will shed light on this controversial dichotomy-innovation versus patient's care.
创新对于医学的整体进步至关重要，对外科手术而言尤其如此。30年前微创手术的引入引发了一场革命，改变了我们如今治疗外科疾病的方式，因为现在大多数手术都避免做大切口，从而使术后疼痛减轻、住院时间缩短，患者能更快恢复日常活动。然而，任何创新要成为标准治疗方法，必须满足以下标准：（1）它可行吗？（2）它安全吗？（3）它能为患者和医疗保健系统带来临床优势吗？食管贲门失弛缓症的治疗就是一个创新——经口内镜下肌切开术的例子，尽管该手术可行且安全，但在没有明确证据表明其能改善患者预后并为医疗保健系统带来优势的情况下，它已成为标准治疗方法。回顾过去30年食管贲门失弛缓症的治疗情况，将有助于阐明这一有争议的二分法——创新与患者护理。
