Complications of Antireflux Surgery.
Complications of Antireflux Surgery.
复制标题
抗反流手术的并发症。
DOI：
10.1038/s41395-018-0115-7
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发表时间：
2018-08
期刊：
影响因子：
--
通讯作者：
Pandolfino JE
中科院分区：
文献类型：
--
作者：
Yadlapati R;Hungness ES;Pandolfino JE
抗反流手术在解剖学上恢复抗反流屏障，是质子泵抑制剂（PPI）难治性胃食管反流疾病或PPI不耐受的治疗选择。腹腔镜下翻底术是标准的抗反流手术，但由于担心包裹的耐久性和不良事件，其受欢迎程度有所下降。由于食管胃交界是一个解剖学上复杂的动态区域，受机械应力的影响，膜很容易断裂、疝出或滑脱。此外，重新创建一个抗反流屏障来平衡双向静脉注射是具有挑战性的，而且绷带可能太紧或太松。鉴于这些复杂性，盆底折叠后的症状和并发症很常见也就不足为奇了。围手术期死亡率在0.1-0.2%之间，高达30%的病例发生长期结构性并发症。上消化道内窥镜与全面的眼底后弯检查和钡餐食管造影是评估结构性并发症的主要检查。治疗取决于区分哪些并发症可以通过医疗和生活方式优化来控制，哪些需要手术修复。再手术最好保留在严重的结构异常和麻烦的症状，尽管药物和内窥镜治疗，由于其增加的发病率和死亡率。虽然需要进一步的数据，磁性括约肌增强术可能是一种更安全的替代方法。
Antireflux surgery anatomically restores the antireflux barrier and is a therapeutic option for proton pump inhibitor (PPI) refractory gastroesophageal reflux disease or PPI intolerance. Laparoscopic fundoplication is the standard antireflux surgery, though its popularity has declined due to concerns regarding wrap durability and adverse events. As the esophagogastric junction is an anatomically complex and dynamic area subject to mechanical stress, wraps are susceptible to disruption, herniation or slippage. Additionally, recreating an antireflux barrier to balance bidirectional bolus flow is challenging, and wraps may be too tight or too loose. Given these complexities it is not surprising that post-fundoplication symptoms and complications are common. Perioperative mortality rates range from 0.1–0.2% and prolonged structural complications occur in up to 30% of cases. Upper gastrointestinal endoscopy with a comprehensive retroflexed examination of the fundoplication and barium esophagram are the primary tests to assess for structural complications. Management hinges on differentiating complications that can be managed with medical and lifestyle optimization versus those that require surgical revision. Reoperation is best reserved for severe structural abnormalities and troublesome symptoms despite medical and endoscopic therapy given its increased morbidity and mortality. Though further data is needed, magnetic sphincter augmentation may be a safer alternative to fundoplication.
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DOI：
10.1007/s00464-017-5859-4
发表时间：
2018-04
期刊：
Surgical endoscopy
影响因子：
--
作者：
Buckley FP 3rd;Bell RCW;Freeman K;Doggett S;Heidrick R
通讯作者：
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影响因子：
2.7
作者：
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影响因子：
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作者：
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通讯作者：
HOGAN, WJ
DOI：
10.1007/s00464-006-0042-3
发表时间：
2006-11-01
影响因子：
3.1
作者：
Finks, Jonathan F.;Wei, Yongliang;Birkmeyer, John D.
通讯作者：
Birkmeyer, John D.
影响因子：
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作者：
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