当Heller肌肉切除术失败时该怎么做:气动扩张,重复Heller或口腔内镜肌肉切除术?
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.
概括
赫勒肌切除术后的反复食是很常见的. 有效的治疗方法包括气动扩张,重复赫勒肌切除术和口腔内镜肌切除术 (POEM),POEM在试验中显示出更高的疗效.
科学领域:
- 胃肠病学
- 外科创新
- 消化道运动障碍
背景情况:
- 赫勒肌切除术是一种常见的治疗方法.
- 在肌肉切除术后,多达20%的患者会出现症状的复发,包括食障碍.
- 肌肉切除术后食不良的原因包括不完整的肌肉切除术和胃食管逆流.
研究的目的:
- 审查在赫勒肌肉切除术后出现持续或复发症状的患者的治疗选择.
- 讨论各种治疗方法的结果,优点和缺点.
- 突出最近内镜管理的进展.
主要方法:
- 文献审查和现有治疗策略的综合.
- 对肌肉切除术后消化不良的诊断方法的分析.
- 对气动扩张,重复赫勒肌肉切除和口腔内镜肌肉切除 (POEM) 的临床结果的评估.
主要成果:
- 诊断工具包括对比研究,内镜和食道运动评估.
- 肺部扩张可以作为主要或辅助疗法.
- 尽管存在技术上的挑战,但Redo Heller肌肉切除的效率很高 (69-100%).
- 与空气扩张相比,POEM在失败的赫勒肌瘤中表现出更高的疗效.
- 在特定的患者群体中,口腔复合是一种新的选择.
结论:
- 通过病史和检测进行准确的诊断至关重要.
- 肺部扩张,重复赫勒肌切除和POEM对于复发症状是有效的.
- 在管理失败的赫勒肌切除术结果方面,
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