导尿管球囊扩张治疗环咽肌失弛缓症2例报告

Stretching the cricopharygeus muscle by urethral catheter balloon dilatation: a novel approach to treating dysphagia caused by cricopharyngeal achalasia

目的探讨导尿管球囊扩张治疗环咽肌失弛缓症的可行性,客观评价其治疗效果。方法放射性脑病、脑干梗死伴吞咽障碍患者各1例,经吞咽X线荧光透视检查和光纤内窥镜吞咽检查,拟诊环咽肌失弛缓症。利用14号导尿管球囊,采用注水方式使球囊充盈,牵拉导尿管,自下而上缓慢移动球囊,使球囊反复多次通过狭窄的食道入口,逐渐扩张环咽肌。同时在颈部结合Vitalstim神经肌肉低频电刺激,进食指导训练。结果分别给予4次及15次扩张治疗后,2例患者均可独立自主进食糊状食物,无呛咳。吞咽造影复查显示在食团通过时,环咽肌正常开放,误吸消失。结论导尿管球囊扩张术能有效缓解环咽肌失弛缓,操作简单,安全可靠。吞咽动态造影是明确诊断及疗效评价必不可少的检查方法。

Objective To investigate the feasibility of using a urethral catheter balloon to treat cricopharyngeal achalasia, and to evaluate its therapeutic effect objectively. Methods Two cases of dysphagia （one caused by radiation encephalopathy and the other by brain stem infarction） were diagnosed as cricopharyngeal achalasia through a videofluoroscopic swallowing study （VFSS） and a fiberoptic endoscopic evaluation of swallowing （FEES）. A #14 urethral catheter was inserted into the esophagus and water was injected into the catheter＇s balloon to expand it. The catheter was then pulled upwards through the stricture of the esophagus to stretch the cricopharygeus muscle. VitalStim low frequency electrical stimulation was applied simultaneously through electrodes placed on the neck. Food intake training was also provided. Results Both patients could cat pasty food independently without bucking after 4, and in the other case 15 stretching sessions. Subsequent swallowing visualization showed that when a bolus passed through the entrance of the esophagus, the cricopharygeus muscle relaxed normally, and aspiration disappeared. Conclusion Urethral catheter balloon dilatation therapy is effective in alleviating dysphagia caused by crieopharyngeal achalasia. This method is easy to operate, safe and reliable. Swallowing dynamic visualization is a necessary test for achalasia diagnosis and treatment.