胃と腸59巻9号

2024年09月発行

今月の主題 食道運動障害の診断と治療

主題

食道運動障害に対する外科的治療

著者： 増田隆洋¹ 福島尚子¹ 坂下裕紀¹ 竹内秀之¹ 星野真人¹ 坪井一人¹ 小村伸朗¹ 矢野文章¹

所属機関： ¹東京慈恵会医科大学外科学講座上部消化管外科

ページ範囲：P.1249 - P.1257

文献概要

要旨●外科的治療が選択肢となる食道運動障害として，食道アカラシア，esophagogastric junction outflow obstruction，および，びまん性食道痙攣（DES）が挙げられる．食道筋層切開術は有効な治療選択肢と考えられている．また，食道運動障害の代表的疾患の一つに食道無蠕動があるが，重症胃食道逆流症（GERD）のリスクとなり得る．薬物コントロール不良なGERDに対しては逆流防止手術が考慮されるが，食道無蠕動患者に対する逆流防止手術は術後に食餌通過障害を来すリスクが高まる．本稿では食道運動障害を有する患者に対する外科的治療について適応と治療成績，手術手技について最近のエビデンスを含めて詳解する．

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