Patel Deven C, Yang Stephen C
Department of Surgery, Houston Methodist Hospital, 6550 Fannin Street, SM1661, Houston, TX 77030, USA.
Division of Thoracic Surgery, Department of Surgery, The Johns Hopkins Medical Institutions, 600 N. Wolfe Street, Blalock 240, Baltimore, MD 21287, USA.
Adv Surg. 2025 Sep;59(1):309-324. doi: 10.1016/j.yasu.2025.05.006. Epub 2025 Jun 27.
Achalasia is a chronic esophageal disorder marked by impaired motility, including the loss of peristalsis and incomplete lower esophageal sphincter relaxation, leading to food retention and progressive esophageal dilation. Diagnosis relies on high-resolution manometry, barium swallow, and endoscopy to classify subtypes. Treatment primarily involves minimally invasive myotomy procedures like Heller and per oral endoscopic myotomy. In advanced cases with significant dilation or complications, esophagectomy becomes necessary, utilizing techniques such as gastric pull-up, colon, or jejunal interposition for reconstruction. These surgeries require specialized centers and careful patient selection to optimize outcomes, with research needed to refine management strategies for end-stage achalasia.
贲门失弛缓症是一种慢性食管疾病,其特征为动力障碍,包括蠕动丧失和食管下括约肌不完全松弛,导致食物潴留和食管进行性扩张。诊断依赖于高分辨率测压、吞钡造影和内镜检查以对亚型进行分类。治疗主要涉及如赫勒肌切开术和经口内镜肌切开术等微创肌切开手术。在出现明显扩张或并发症的晚期病例中,食管切除术成为必要,利用诸如胃上提术、结肠或空肠间置术等技术进行重建。这些手术需要专业中心并仔细选择患者以优化治疗效果,对于终末期贲门失弛缓症的管理策略还需要开展研究以进行完善。