球囊扩张术结合手法治疗对环咽肌失弛缓症所致吞咽障碍的疗效观察

Effect of balloon dilatation therapy and Mendelsohn method on dysphagia caused by cricopharyngeal achalasia

目的:探讨导管球囊扩张术结合手法治疗对环咽肌失弛缓症所致吞咽障碍的治疗作用。方法:第1阶段:50例吞咽障碍患者均接受导管球囊扩张术及常规吞咽康复训练,治疗终点为恢复经口进食或治疗已满4周。第2阶段:对第1阶段治疗效果不佳的患者分为2组,对照组仍旧沿用第1阶段的治疗方法,观察组改用门德尔松手法及shaker训练法进行治疗,治疗终点为恢复经口进食或治疗满2周。结果:第1阶段治疗后,50例患者中有19例进食功能完全无改善,分为观察组10例及对照组9例进行第2阶段治疗。治疗后,观察组吞咽障碍功能等级评分较治疗前及对照组显著提高(P<0.05),饮水试验评分较治疗前及对照组显著下降(P<0.05)。结论:导管球囊扩张术对环咽肌失弛缓所致吞咽困难疗效显著,但对存在喉部向上和向前的动作不足的患者无法达到立竿见影的效果,需结合相应的手法才能达到治愈的目的。

Objective：To investigate the effects of catheter balloon dilatation therapy for dysphagia caused by crico- pharyngeal achalasia. Methods： On the first stage, 50 patients were treated with routine dysphagia rehabilitation training and balloon dilatation therapy. The treatment end point was either oral diet or after 4 week treatment. On the second stage, the patients whose therapeutic effect was not improved were divided into two groups. The control group was given the treatment on the stage 1 and the observation group was given Mendelsohn method and Shaker method. The treatment end point was either oral diet or after 2-week treatment. Results：After treatment of the first stage, 19 of the 50 patients had no significant effectiveness,and divided into the observation group （n= 10） and the control group （n= 9）. After treatment, the dysphagia functional score of the observation group was signi{icantly higher than before the treatment and that of the control group （P〈0. 05）. The score of Water swallow tests was lower significantly in the observation group than before the treatment and that in the control group （P〈0.05）. Con- clusion：Catheter balloon dilatation therapy is effective for dysphagia caused by cricopharyngeal achalasia, but it can＇t reach to get instant results if upward and forward movements of the larynx were insufficient. It must be combined with the corresponding means to achieve the purpose of healing.