内镜超声引导下肉毒杆菌毒素注射治疗贲门失弛缓症临床疗效观察

The effect of Botulinum Toxin local injection on patients with achalsia guided by endoscopic ultrasonography

目的探讨超声胃镜引导下肉毒杆菌毒素注射治疗贲门失弛缓症的临床疗效。方法45例贲门失弛缓症患者，分为球囊扩张、肉毒杆菌毒素注射及Heller手术3组，观察治疗前、治疗后6个月和12个月患者临床症状计分和钡餐检查中食管宽度。结果3组患者治疗后吞咽困难、胸痛和反流症状的计分以及食管钡餐检查食管最大宽度均明显低于治疗前（P〈0．05），且3组间临床症状改善程度差异无统计学意义（P〉0．05），但扩张组和Heller手术组各有1例发生食管穿孔并发症，肉毒杆菌毒素组无并发症发生，患者耐受良好。结论超声胃镜引导下肉毒杆菌毒素注射是治疗贲门失弛缓症安全、有效的方法。

Objective To explore the efficacy and safety of intrasphincteric botulinum toxin（BT） injection in paitients with achalasia guided by endoscopic uhrasonography. Methods Forty-five patients diagnosed as achalasia by clinical features were divided into three groups, group one （ balloon dilation, n = 15）, group two （intrasphincteric BT injection, n = 21 ） and group three （Heller surgery, n = 9）. The following parameters were evaluated： the symptom score, the maximal width of esophagus on barium radiography before and after treatment 6 month and 12 months. Results Parameters of symptom score and the maximal esophagus width were significantly decreased （P 〈 0.05）, the improvement of symptom between three groups had no significance（P 〉0. 05）, But there was one patient perforated in dilation group and Heller surgery group respectively. Conclusion BT local injection in paitients with achalasia introduced by endoscopic ultrasonography could significantly improve symptoms of achalasia. It is a safe and effective method for treatment of achalasia.