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失驰缓症的手术治疗：腹腔镜手术与开放式Heller肌切开术

Authors
Brant K Oelschlager, MD
Rebecca P Petersen, MD, MSc
Section Editor
Joseph S Friedberg, MD
Deputy Editor
Rosemary B Duda, MD, MPH, FACS
Translators
王秋生, 主任医师，教授

引言

1913年，Heller描述了一种治疗失驰缓症的手术方法[1,2]。Heller肌切开术联合胃底折叠术是治疗失驰缓症的最佳手术方法，症状有效控制率可达90%-97%[3,4]。通过腹腔镜手术或开放手术可切开下食管括约肌的肌纤维，且不破坏食管的黏膜层。随着腹腔镜手术的进展，开放式手术已很少进行。

本文将总结Heller肌切开术的手术指征、手术技巧感悟和术后疗效。失驰缓症的病理生理学、病因、临床表现、诊断和内科治疗将在别处讨论。 (参见“失弛缓症治疗概述”和“食管失弛缓症的病理生理学和病因学”和“失弛缓症的临床表现和诊断”和“气囊扩张与肉毒毒素注射治疗贲门失驰缓症”)

选择患者的标准

选择适合手术治疗的患者的关键方面是鉴别失弛缓症和其他食管动力性疾病，以及鉴别失弛缓症和假性失驰缓症、食管恶性肿瘤和食管机械性梗阻。外科医生的术前评估包括询问患者有症状以来的病史，以及回顾既往检查的结果和内科治疗对缓解症状的效果。例如，对于一位50岁以上、症状持续时间少于6个月和/或体重下降10磅(4.5kg)以上的患者，必须评估是否存在食管癌。

术前评估的相关详细内容如下：

  • 年龄
  • 体重减轻史
  • 症状持续的时间
  • 食管功能的生理学检查
  • 放射影像学检查
  • 扩张治疗的结果
  • 注射肉毒毒素后的情况
  • 活检结果
  • 既往胸腔内及腹腔内手术史
  • 共存疾病

                           

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Literature review current through: 2017-06 . | This topic last updated: 2016-07-19.
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