内镜下注射A型肉毒毒素治疗贲门失弛缓症

Endoscopic injection of botulinum toxin for achalasia

目的介绍内镜下注射 A型肉毒毒素（ BTXA）治疗贲门失弛缓症 (AC)的方法，探讨其近期疗效。方法原发性 AC患者 13例，于治疗前和治疗后 1周做症状计分和食管造影（测量贲门开口、 5分钟食管存留造影剂的高度和平均宽度）。内镜下于贲门齿状线上 0.5cm分 4点各注射 BTXA 20U至下食管括约肌。结果治疗次日症状即明显缓解，咽下困难频度、咽下困难程度、反食频度、胸骨后疼痛频度计分均明显减少；贲门开口由治疗前的 (1.5± 1.8)mm增大至 (4.4± 2.4)mm， P< 0.001； 5分钟食管碘柱高度和平均宽度分别由治疗前的 (89.5± 37.4)mm和 (31.9± 11.3)mm降至治疗后的 (14.4± 22.0)mm和 (8.4± 9.4)mm， P< 0.001。结论内镜下注射 BTXA治疗 AC安全、经济、简便易行，近期效果良好。

Objective The techniques and early effect of perendoscopic intrasphincteric injection of botulinum toxin (BTXA) for achalasia was introduced and evaluated. Methods 13 patients with achalasia were enrolled in the study.Symptom scoring ( modified ) and esophagography ( measuring cardiac opening,height and width of contrast media retention in 5 minutes ) were performed before and one week after treatment.1 ml of BTXA (20 u) was injected endoscopically at a point of every quadrant (4 points) situated 0.5 cm above the dentate line into the lower esophageal sphincter. Results The symptoms improved remarkably the next day as chest pain,frequency and seriousness of dysphagia and regurgitation declined significantly (P< 0.001). The size of cardiac opening increased from (1.5± 1.8)mm to (4.4± 2.4)mm (P< 0.001) and the height and width of contrast media retention lowered from (89.5± 37.4)mm and (31.9± 11.3) to (14.4± 22.0)mm and (8.4± 9.4)mm (P< 0.001) respectively. Conclusion Perendoscopic intrasphincteric injection of BTXA toxin is simple and safe with immediate effectiveness for achalasia.