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:

胃食管反流病（GERD）主要由食管下括约肌（LES）功能障碍所致，使胃内容物反流入食管，从而引发反流症状、黏膜损伤并降低生活质量。传统的抗反流手术方式，如Nissen、Toupet及Dor胃底折叠术，旨在增强LES功能并重建抗反流屏障的生理与机械组成部分，但术后吞咽困难、胀气综合征、持久性不足及远期复发等问题，限制了其更广泛的应用。随着微创外科技术的不断发展，假体型LES增强装置——包括磁性LINX^TM系统和RefluxStop^TM硅胶植入物——作为可逆、保留解剖结构的新型替代方案应运而生，其设计目标是在直接增强括约肌功能的同时，尽可能减少常见并发症的发生。本文综述了食管胃结合部的功能解剖、抗反流手术的基本原理以及胃底折叠术失败的机制。来自短期及长期随访研究的证据表明，磁性括约肌增强术及RefluxStop手术均可有效降低食管酸暴露，改善GERD相关生活质量，并在食管动力障碍或既往抗反流手术失败的患者中仍能获得持久的抗反流效果。这些技术是对传统胃底折叠术的重要补充，为GERD的个体化治疗提供了更加丰富的选择。未来，通过进一步优化患者筛选、手术技巧及长期疗效评估，将有助于明确 LES增强技术在现代抗反流外科中的最佳定位。

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 LINX^TM system and the RefluxStop^TM 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.