肉毒毒素治疗贲门失弛缓症前后胃食管pH值监测分析

Gastroesophageal pH monitoring of achalasia before and after endoscopic injection of botulinum toxin:an analysis of 16 patients

目的 评价肉毒毒素注射疗法治疗贲门失弛缓症是否会引起胃食管反流。 方法 对 16例贲门失弛缓症患者进行肉毒毒素注射 ,于贲门齿状线上 0 5cm水平分 4点、贲门下分 1～ 2点行食管括约肌内注射 ,治疗前和治疗后 7d做症状计分、胃食管pH监测和食管碘水造影进行对比分析。 结果 注射后症状计分明显减低 ,食管造影明显改善 ,未出现胃食管反流的症状 ,胃液pH无明显变化 ,食管pH、食管pH≤ 4的次数、食管pH≤ 4时间总和、食管pH≤ 4持续时间≥ 5min的时间总和、最长反流时间等各项胃食管反流的指标均无明显差异 (P >0 0 5 )。 结论 内镜下注射肉毒毒素治疗贲门失弛缓症不会引起胃食管反流 ,其方法简便 ,近期疗效确切 。

Objective To observe whether treating achalasia with botulinum toxin results in gastroesophageal reflux Methods Clinical data, gastroesophageal pH monitoring and timed barium swallow fluoroscopic findings of sixteen patients with achalasia diagnosed by symptoms, endoscopy and fluroscopy were recorded and analyzed before and seventh day after therapy with botulinium toxin 100 U of botulinum toxin A injection in four quadrants (1 ml in each quadrant 20 U/ml) at the level beyond cardia and two points below cardia respectively. Results The symptom scores were reduced significantly after the therapy and timed barium swallow fluoroscopy improved. There was no any gastresophageal reflux symptom (heartburn and acid reflux) in all patients after the therapy. The pH of gastric juice had not changed after the therapy There was no significant difference( P >0 05) before and after therapy in esophgeal pH, times of esophageal pH≤4, summation of period of esophageal pH≤4 , summation of period≥5 minutes of esophageal pH≤4, and longest period of gastroesophageal reflux. Conclusions Endoscopic injection of botulinum toxin for achalasia is simple and convenient, and can not result in gastroesophgeal reflux. There is a good short time response and no any toxic and side effect in almost all patients.