During the operation, the muscles of the cardiac sphincter are dissected and the resulting incision is covered with the wall of the stomach. Unfortunately, not many clinics have experience in the surgical treatment of achalasia of the cardia, and therefore the optimal methods of surgical treatment of the surgical treatment of achalasia of the cardia are not always used. One of the greatest experiences had the clinic of prof.
Onoprieva (Russian Center for Functional Surgical Gastroenterology, Krasnodar). This clinic has developed a unique method for the elimination of achalasia cardia, which allows achieving good results in 97%. Surgical treatment of amoxil cardia. The method consists in delicate isolation of the esophagus, dissection of the muscular layer of the esophagus and cardia without opening the mucosa, and subsequent plastic surgery aimed at preventing the recurrence of achalasia and preventing reflux esophagitis.
The results were tracked for 25 years, relapses were detected in 3%. Achalasia of the cardia, like any long-term disease, the easier it is to treat, the earlier the patient turned for specialized help. Achalasia cardia is the lack of relaxation or insufficient relaxation of the lower esophagus of neurogenic etiology. Accompanied by a disorder of the reflex opening of the cardiac opening during the act of swallowing and a violation of the ingress of food masses from the esophagus into the stomach.
Achalasia cardia is manifested by dysphagia, regurgitation and pain in the epigastrium. The leading diagnostic methods are fluoroscopy of the esophagus, esophagoscopy, esophagomanometry. Conservative treatment consists in carrying out pneumocardiodilatation; surgical - in performing cardiomyotomy.
Causes Pathogenesis Classification Symptoms of achalasia cardia Complications Diagnosis Treatment of achalasia cardia Prognosis and prevention Prices for treatment. Achalasia of the cardia in the medical literature is sometimes referred to by the terms megaesophagus, cardiospasm, idiopathic dilatation of the esophagus. Achalasia of the cardia, according to various sources, in practical gastroenterology ranges from 3 to 20% of all diseases of the esophagus.
Among the causes of Amoxicillin obstruction, cardiospasm ranks third after esophageal cancer and post-burn cicatricial strictures. Pathology with the same frequency affects women and men, more often develops at the age of 20-40 years. With achalasia of the cardia, as a result of neuromuscular disorders, the peristalsis and tone of the esophagus decrease, there is no reflex relaxation of the esophageal sphincter when swallowing, which makes it difficult to evacuate food from the esophagus to the stomach.
Many etiological theories of the origin of achalasia cardia have been put forward, which associate the development of pathology with a congenital defect of the nerve plexuses of the esophagus, secondary damage to nerve fibers in tuberculous bronchoadenitis, infectious or viral diseases; vitamin B deficiency, etc.
The concept of violations of the central regulation of the functions of the esophagus is widespread, considering achalasia of the cardia as a result of neuropsychic injuries leading to a disorder of cortical neurodynamics, innervation of the esophagus, and discoordination in the work of the cardiac sphincter. However, the factors contributing to the development of the disease remain unclear.
The leading role in the pathogenesis of achalasia cardia is assigned to the defeat of the parts of the parasympathetic nervous system that regulates the motility of the esophagus and stomach (in particular, the Auerbach plexus). Secondary (symptomatic) achalasia of the cardia can be caused by infiltration of the plexus by a malignant tumor (adenocarcinoma of the stomach, hepatocellular cancer, lymphogranulomatosis, lung cancer, etc.). In some cases, the Auerbach's plexus can be affected in myasthenia gravis, hypothyroidism, poliomyositis, and systemic lupus erythematosus.
The actual denervation of the upper gastrointestinal tract causes a decrease in peristalsis and tone of the esophagus, the impossibility of physiological relaxation of the cardiac opening during the act of swallowing, and muscle atony. With such disorders, food enters the stomach only due to the mechanical opening of the cardiac opening, which occurs under the hydrostatic pressure of liquid food masses accumulated in the esophagus. Prolonged stagnation of the food bolus leads to the expansion of the esophagus - megaesophagus.
Macroscopic changes (stenosis of the cardia and suprastenotic expansion of the lumen of the esophagus) are not observed. II stage. Spasm of the cardia is stable, there is a slight expansion of the esophagus. Stage III. Cicatricial deformity of the muscular layer of the cardia and a sharp suprastenotic expansion of the esophagus are revealed. IV stage. It proceeds with a pronounced stenosis of the cardiac section and a significant dilatation of the esophagus.
According to the severity of esophageal dysfunction, the stages of compensation, decompensation and sharp decompensation of achalasia of the cardia are distinguished. Among the many proposed classification options, the largestThe following staging option is of clinical interest: I stage. It is characterized by intermittent spasm of the cardiac region.
Morphological changes in the wall of the esophagus depend on the duration of the existence of achalasia cardia. At the stage of clinical manifestations, there is a narrowing of the cardia and expansion of the lumen of the esophagus, its elongation and S-shaped deformation, coarsening of the mucous membrane and smoothing of the folding of the esophagus. Microscopic changes in achalasia of the cardia are represented by hypertrophy of smooth muscle fibers, proliferation of connective tissue in the esophageal wall, pronounced changes in the intermuscular nerve plexuses.