Indications du traitement chirurgical dans l’endobrachyœsophage
Tóm tắt
La chirurgie anti-reflux est indiquée chez les porteurs d’un endobrachyœsophage uniquement après échec du traitement médical car le traitement chirurgical ne procure, ni une régression complète de l’épithélium métaplasique, ni une prévention du développement ultérieur de la dysplasie et/ou de l’adénocarcinome. L’endobrachyœsophage avec sténose doit être traité par dilatations ou en cas d’échec, par chirurgie anti-reflux associée à une dilatation per-opératoire. Les sténoses résistantes aux dilatations justifient la résection avec reconstruction appropriée conçue en vue de prévenir le reflux acide. Les ulcères de Barrett peuvent, dans la majorité des cas, être traités avec succès par les moyens médicaux. La chirurgie anti-reflux est efficace lorsque le traitement médical échoue. Les complications telles que les hémorragies massives ou la perforation, nécessitent indiscutablement un traitement chirurgical. L’œsophago-gastrectomie est recommandée pour les patients dont les biopsies démontrent une dysplasie de haut degré et/ou un carcinome in situ, de même qu’en cas de cancer invasif.
Tài liệu tham khảo
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