胃食管反流的力学基础与外科治疗策略OA北大核心CSTPCD

Hiatal hernia(HH)and gastroesophageal reflux disease(GERD)are commonly encountered digestive system disorders in clinical practice.Anti-reflux surgery is a crucial method for their treatment.As a surgeon,the level of understanding of such diseases can significantly impact the efficacy of the surgical interventions.Physiological reflux has a certain correlation with biological evolutionary rumination,which may provide a target for the prevention and treatment of GERD at the molecular level in the future.The pressure difference in the thoracoabdominal cavity and relaxation of the lower esophageal sphincter,especially the excessive occurrence of transient sphincter relaxation(tLESR),underlie the dynamics of pathological reflux.The spatial position of the Lower esophageal sphincter(LES),Crural diaphragm(CD),and gastroesophageal valve(GEV)are important anti-reflux barriers.From the perspective of mechanics,this paper proposes that a hiatal hernia is an axial hernia,which destroys the normal anti-reflux barrier,and can gradually develop from mild to severe.The surgical strategy for hiatal hernia surgery is to reconstruct the anti-reflux structure:through the free extension of the lower end of the esophagus and the length of the LES,the folding circle outside and the gastroesophageal valve inside formed by the fundoplication,as well as the LES-CD formed by centripetal suture are in place at the same time to form a stable anti-reflux system exposed to the abdominal cavity to improve the function and cure the disease.