臨床外科60巻13号

2005年12月発行

特集 消化管機能温存を考えた外科手術最前線

〔機能性疾患の外科最前線〕

アカラシアに対する腹腔鏡下手術

著者： 柏木秀幸¹ 小村伸朗¹ 坪井一人¹ 矢野文章¹ 石橋由朗¹ 矢永勝彦¹

所属機関： ¹東京慈恵会医科大学外科

ページ範囲：P.1525 - P.1533

文献概要

要旨：アカラシアに対する治療として，1990年代から内視鏡下手術が行われるようになってきた．胸腔鏡下Heller筋層切開術と腹腔鏡下Heller筋層切開術＋噴門形成術である．特に腹腔鏡下Heller筋層切開術＋噴門形成術は，確実な通過障害の改善効果と逆流防止効果を有するために，アカラシアに対する治療の第一選択となりつつある．一方，保存的治療として拡張治療が行われているが，若年者では再発が起こりやすいため，最初から腹腔鏡下手術の選択がある．また，拡張治療の既往は，内視鏡下手術の治療成績に影響を与える可能性はあるが，その影響は少ない．重症例や術後再発例に対しても内視鏡下手術が行われるようになってきたが，良好な成績を得るためにも，手術手技の習熟が必要である．

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