Journal of Experimental and Clinical Surgery

Вестник экспериментальной и клинической хирургии

2070-478X2409-143X

Voronezh State Medical University named after N.N. Burdenko

1259

10.18499/2070-478X-2019-12-1-62-70

Review of literature

Обзор литературы

Unknown

Esophagectomy for End-Stage Achalasia

Эзофагэктомия как способ радикального лечения ахалазии кардии терминальной стадии

https://orcid.org/0000-0001-9068-3922

2587-8568

Ruchkin

Dmitry Valerievich

Ручкин

Дмитрий Валерьевич

Russian Federation

doct. of med. scie.,, the chief of the upper digestive tract reconstructive surgery department of A.V. Vishnevsky National Medical Research Center of Surgery

дмн, руководитель группы реконструктивной хирургии пищевода и желудка ФГБУ НМИЦ хирургии им. А.В. Вишневского

ruchkindmitry@gmail.com

https://orcid.org/0000-0001-7460-4884

2176-2813

Okonskaya

Diana Evgenievna

Оконская

Диана Евгеньевна

Russian Federation

graduate student in "surgery" of A.V. Vishnevsky National Medical Research Center of Surgery

аспирант группы реконструктивной хирургии пищевода и желудка ФГБУ НМИЦ хирургии им. А.В. Вишневского

cool_green_alien@mail.ru

https://orcid.org/0000-0002-8576-0900

7936-7210

Yan

Maria Nikolaevna

Ян

Мария Николаевна

Russian Federation

junior researcher of upper digestive tract reconstructive surgery department of A.V. Vishnevsky National Medical Research Center of Surgery

младший научный сотрудник группы реконструктивной хирургии пищевода и желудка ФГБУ НМИЦ хирургии им. А.В. Вишневского

yanmaria88@mail.ru

A.V. Vishnevsky National Medical Research Center of Surgery, Moscow, RussiaНМИЦ хирургии им. А.В. Вишневского Минздрава России

A.V. Vishnevsky National Medical Research Center of Surgery, Moscow, RussiaНациональный медицинский исследовательский центр хирургии им. А.В. Вишневского

02032019

121

62700801201927012019

2019

Ruchkin D., Okonskaya D., Yan M.

Ручкин Д.В., Оконская Д., Ян М.

http://creativecommons.org/licenses/by-nc-nd/4.0

https://vestnik-surgery.com/journal/article/view/1259

Treatment for achalasia of cardia is multidirectional nowadays and depends on several factors such as patient’s sex and age, type and stage of disease, co-morbidity and complications. However the treatment for end-stage achalasia is still controversial. Ones who advocate organ preservation surgery consider esophagectomy an ultima ration. These authors conceive that esophagectomy is too traumatic for benign disease with low progression. Esophagectomy as a first approach for end-stage achalasia is recommended by others authors who believe that progredient course of disease (nonreversible strongly dilated and atonic esophagus), debilitating dysphagia, regurgitation, aspiration syndrome and ineffective intervention in cardia make the extirpation of the esophagus necessary. Persistent degeneration of life quality and high possibility of such devastating symptoms as aspiration and esophageal cancer alongside with unacceptable results of myotomy raise questions on the effectiveness of the organ preservation surgery for end-stage achalasia

До сих пор существуют разнонаправленные тенденции лечения ахалазии кардии: в зависимости от стадии и типа заболевания, сопутствующей патологии, возраста, пола, а также наличия осложнений. Остается спорным вопрос, какой способ лечения наиболее обоснован у больных с АК терминальной стадии. Сторонники органосохраняющего метода лечения считают эзофагэктомию (ЭЭ) крайней мерой, аргументируя это тем, что экстирпация пищевода является травматичным вмешательством. Сторонники же радикального метода лечения выступают за приоритетное выполнение эзофагэктомии при АК терминальной стадии. С их точки зрения, прогрессирование заболевания, неэффективность ранее проведенных вмешательств на кардии, изнуряющая дисфагия, пептическая стриктура, как следствие неконтролируемого рефлюкс-эзофагита, аспирационные осложнения обусловливают необходимость удаления пищевода. Значительное снижение качества жизни, высокий риск развития такого жизнеугрожающего осложнения, как аспирационный синдром, риск развития рака пищевода, а также неудовлетворительные результаты ранее проведенного лечения ставят под сомнение целесообразность органосохраняющих вмешательств у пациентов с АК терминальной стадии.

end-stage achalasia, megaesophagus, aspiration, treatment, esophagectomy

ахалазия кардии IV стадии, кардиоспазм, эзофагэктомия, аспирационный синдром

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