胃食管反流病外科治疗的演变  

Evolution in the treatment of gastroesophageal reflux disease

作　　者：翁飞龙 费浩然 沈晓军[1] 孙克康[1] Weng Feilong;Fei Haoran;Shen Xiaojun;Sun Kekang(Department of Gastrointestinal Surgery,Affiliated Kunshan Hospital to Jiangsu University,Kunshan 215300,China)

机构地区：[1]江苏大学附属昆山医院胃肠外科,昆山215300

出　　处：《国际外科学杂志》2025年第1期64-68,共5页International Journal of Surgery

摘　　要：随着对胃食管结合部抗反流屏障理解的加深,胃食管反流病的外科治疗策略也在不断变化。最初手术的重点是治疗食管裂孔疝和膈肌脚的关闭,然而一些患者术后反流症状持续存在。随着食管测压技术的出现和食管下段高压区的发现,手术的重点逐渐转向食管下括约肌,包括His角重建、恢复腹段食管长度,胃底折叠术及磁性括约肌增强术等。由于术后较高的复发率,缝合膈肌脚在抗反流屏障和食管裂孔疝修补中的作用再次受到关注。与最初通过缝合膈肌脚防止胃疝入胸腔不同,缝合膈肌脚被证实在恢复腹段食管长度和维持食管下括约肌(LES)压力方面起着关键作用。近年来补片的应用为加强膈肌脚提供了更多的选择。本文将回顾过去一个世纪胃食管反流病的外科治疗策略的演变,以期更好地指导胃食管反流病的外科治疗和临床研究。The surgical management of gastroesophageal reflux disease has evolved significantly with the increased understanding of the physiology of the reflux barrier.Initially,emphasis was on reduction of hiatal hernias and crural closure.With persistence of reflux symptoms,along with the development of esophageal manometry and the discovery of a high-pressure zone,focus evolved to surgical augmentation of the lower esophageal sphincter,including reconstruction of the angle of His,ensuring sufficient intra-abdominal esophageal length,fundoplication,and magnetic sphincter augmentation.More recently,the role of crural closure in antireflux and hiatal hernia repair has again received renewed attention due to the persistence of postoperative complications and recurrences.Rather than simply preventing transthoracic herniation of the fundoplication as was originally thought,crural closure has been documented to have a critical role in re-establishing intra-abdominal esophageal length and maintaining the pressure of LES.The application of mesh provides more options for strengthening crural closure.In this review,this article will discuss the evolution of surgical techniques for gastroesophageal reflux disease over the past century,aiming to better guide the surgical treatment and clinical research of gastroesophageal reflux disease.

关 键 词：胃食管反流 疝 食管裂孔 外科手术 

分 类 号：R655.4[医药卫生—外科学]