ヘラー筋切開が失敗したらどうする? 肺拡張,ヘラー再手術,または口腔内視鏡筋切開?
Sullivan A Ayuso1, Michael B Ujiki2
1Division of Elective General Surgery, Department of Surgery and Perioperative Care, Dell Medical School, The University of Texas at Austin, Austin, TX, United States.
まとめ
ヘラー筋切除手術の後に再発する 消化不全は一般的です 有効な治療には,肺拡張,再ヘラー筋切除,口腔内視鏡筋切除 (POEM) が含まれており,POEMは試験で優れた有効性を示しています.
科学分野:
- 胃腸内科
- 外科 革新
- 食道運動障害
背景:
- ヘラー筋切除は アハラシアの一般的な処置です
- ミオトミー後の症状の再発は,ジスファギアを含む患者の20%まで発生します.
- ミオトミー後の消化不全の原因には,不完全なミオトミーと胃食道逆流が含まれます.
研究 の 目的:
- ヘラー筋切除術後の症状が持続または再発する患者の治療方法を検討する.
- 様々な治療方法の 結果,メリット,デメリットについて議論する.
- エンドスコピーの管理における最近の進歩を強調する.
主な方法:
- 文献のレビューと利用可能な治療戦略の統合.
- ミオトミー後の消化不全の診断方法の分析
- 肺拡張,再ヘラー筋切開,口腔内視鏡筋切開 (POEM) の臨床結果の評価
主要な成果:
- 診断ツールには,コントラスト研究,内視鏡検査,食道運動の評価が含まれます.
- 肺拡張は主療法または補助療法として用いられる.
- Redo Heller myotomyは,技術的な課題にもかかわらず,高い効果 (69-100%) を提供しています.
- 失敗したヘルラー筋切除の肺拡張と比較して,POEMは優れた有効性を示す.
- 口腔移植は特定の患者グループにとって新しい選択肢です.
結論:
- 患者の病歴と検査による正確な診断は極めて重要です.
- 肺の拡張,ヘルラー筋切除,POEMは 症状が再発する時に有効です.
- POEMは失敗したヘルラー筋切除の結果の管理における重要な進歩を表しています.
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