Tasnim Sadia, Raja Siva, Sudarshan Monisha
Digestive Disease and Surgery Institute, Cleveland Clinic Foundation, 9500 Euclid Avenue, Cleveland, OH 44195, USA; Thoracic Surgery, Thoracic and Cardiovascular Surgery Institute, Cleveland Clinic Foundation, 9500 Euclid Avenue, Mail Code J4-1, Cleveland, OH 44195, USA. Electronic address: https://twitter.com/_SadiaTasnim.
Thoracic Surgery, Thoracic and Cardiovascular Surgery Institute, Cleveland Clinic Foundation, 9500 Euclid Avenue, Mail Code J4-1, Cleveland, OH 44195, USA.
Thorac Surg Clin. 2023 May;33(2):135-140. doi: 10.1016/j.thorsurg.2023.01.007. Epub 2023 Feb 26.
Approaches to achalasia include non-operative and operative techniques with Heller Myotomy and Per-Oral Endoscopic Myotomy (POEM) at the forefront of palliative strategies. Given the diverse subtypes and the time-dependent failure pattern for achalasia, there is no standard approach. We elect for a POEM for type III achalasia, poor functional status, hostile abdomen, and salvage after the previous myotomy. A Heller myotomy is elected over a POEM for type II achalasia, presence of diverticulum, and hiatal hernia. As long-term outcomes become available, an optimal customized strategy will become clearer.
贲门失弛缓症的治疗方法包括非手术和手术技术，其中赫勒肌切开术和经口内镜肌切开术（POEM）处于姑息治疗策略的前沿。鉴于贲门失弛缓症的多种亚型和随时间变化的失败模式，目前尚无标准的治疗方法。对于III型贲门失弛缓症、功能状态差、腹部情况复杂以及既往肌切开术后需要挽救治疗的患者，我们选择POEM。对于II型贲门失弛缓症、存在憩室和食管裂孔疝的患者，我们选择赫勒肌切开术而非POEM。随着长期结果的出现，最佳的定制策略将变得更加清晰。
