食管下括约肌增强的新型技术:当代外科实践中的适应证与局限性
Novel technology for lower esophageal sphincter augmentation:indications and limits in current surgical practice
摘要
Abstract
Gastroesophageal reflux disease(GERD)is primarily driven by dysfunction of the lower esophageal sphincter(LES),allowing gastric contents to reflux into the esophagus and leading to symptoms,mucosal injury,and impaired quality of life.Traditional antireflux procedures such as Nissen,Toupet,and Dor fundoplication aim to reinforce the LES and restore the physiological and mechanical components of the antireflux barrier.Yet concerns regarding postoperative dysphagia,gas-bloat,durability,and long-term recurrence have limited their broader adoption.As advances in minimally invasive surgery have progressed,prosthetic LES augmentation devices-including the magnetic LINXTM system and the RefluxStopTM silicone implant-have emerged as reversible,anatomy-preserving alternatives designed to directly enhance sphincter competence while minimizing common complications.This review summarizes the functional anatomy of the esophagogastric junction,core principles of antireflux surgery,and the mechanisms underlying fundoplication failure.Evidence from short-and long-term studies demonstrates that both Magnetic Sphincter Augmentation(MSA)and the RefluxStop procedure effectively reduce acid exposure,improve GERD-related quality of life,and provide durable reflux control,even in patients with impaired esophageal motility or prior failed surgery.These techniques complement traditional fundoplication and offer expanding therapeutic opportunities for personalized GERD management.Continued refinement of patient selection,procedural technique,and long-term evaluation will help define the optimal role of LES augmentation within contemporary antireflux surgery.关键词
胃食管反流/食管下括约肌/括约肌增强/食管裂孔疝/胃底折叠术/LINX手术/RefluxStop手术Key words
Gastroesophageal Reflux/Lower Esophageal Sphincter/LES Augmentation/Hiatal Her-nia/Fundoplication/LINX Procedure/RefluxStop Procedure分类
医药卫生引用本文复制引用
王权,Luigi BONAVINA..食管下括约肌增强的新型技术:当代外科实践中的适应证与局限性[J].中国普通外科杂志,2025,34(11):2310-2317,8.基金项目
Dr. Wang Quan is supported in part by the China Scholarship Council (CSC) Visiting Scholarship Program (No. 202408610128). He is currently an official Visiting Scholar at the Department of Biomedical Sciences for Health, University of Milan, and has also been appointed as a Visiting Professor in the Department of Pharmacy, Health and Nutrition Sciences,University of Calabria for the 2025/2026 academic year. This study was supported by the Standardized Management Research Project on Ambulatory Medical Care of the National Institute of Hospital Administration(NiHA),National Health Commission of the People's Republic of China(Grant No.DSQ20251114),and by the Clinical Research Program of Air Force Medical University—Special Project for Single-Disease Databases(Grant No.2024LC2439). （CSC）
