冰水球囊扩张治疗环咽肌失弛缓症的疗效观察

Therapeutic effect of balloon catheter dilatation with ice water on cricopharyngeal achalasia

目的探讨冰水、常温水球囊扩张对脑干卒中后环咽肌失弛缓症的治疗作用，并进行疗效对比。方法根据人院时间将脑于卒中后环咽肌失弛缓患者（40例）分为2组，实验组患者给予冰水球囊扩张及低频电刺激治疗，对照组则给予常温水球囊扩张及低频电刺激治疗。于治疗前、治疗4周后对2组患者吞咽功能进行评定。结果治疗后2组共有36例患者可独立自主进食糊状食物，电视X线透视吞咽功能检查（VFSS）显示食团在通过咽喉时，其环咽肌均正常开放，食物能顺利通过环咽肌，误吸消失。通过组间比较发现，治疗后2组患者环咽肌开放情况、留置鼻胃管例数、正常进食例数及功能性经口进食量表评分（F01S）组间差异均无统计学意义（P〉0．05），但实验组平均治疗次数[（7．45±2．3）次／例]、平均住院天数[（16．7±4．8）d／例]、平均治疗费用[（6430±874）元／例]均显著优于对照组水平，组间差异均具有统计学意义（P〈0．05）。结论冰水球囊扩张或常温水球囊扩张联合低频电刺激均能有效改善脑干卒中后环咽肌失弛缓导致的吞咽障碍，并且与常温水球囊扩张联合低频电刺激比较，冰水球囊扩张联合低频电刺激能进一步缩短疗程，减轻患者经济负担，该疗法值得临床推广、应用。

Objective To observe the therapeutic effects of balloon dilatation with ice water and room tem- perature water on ericopharyngeal aehalasia after brainstem stroke. Methods Forty dysphagic patients with crico- pharyngeal achalasia after brainstem stroke were recruited. Twenty patients assigned to experimental group were trea- ted by balloon dilatation with ice water and low frequency elecrtrical stimulation. Twenty patients assigned to control group were treated by balloon dilatation with room temperature water and low frequency electrical stimulation. Results After treatment, 36 out of the 40 patients of the two groups could eat pasty food independently without cho- king. Videofluoroscopic swallowing study （VFSS） showed that the cricopharyngeal sphincter relaxed and the foods passed successfully when swallowing bolus, and no aspiration happened. In comparison, the level of cricopharyngeal opening, the number of patients with nasogastric tube remained and eating normally, and the scores of functional oral intake scale （FOIS） between the two groups showed no significant difference （P 〉 0.05 ）. The average treatment ses- sions, average hospitalization days and average treatment cost in treatment group were significantly less than those in the control group（ P 〈 0.05 ）. Conclusion Cricopharyngeal achalasia can be treated effectively by balloon dilata- tion with ice water or with room temperature water combined with low frequency electrical stimulation, but treatment course of balloon dilatation with ice water were significantly shorter than that of balloon dilatation with room tempera- ture water.