超声引导肉毒毒素注射治疗环咽肌功能障碍探讨

Therapeutic Effects of Ultrasound-Guided Injection of Botulinum Toxin Type A into the Cricopharyngeus Muscle for Cricopharyngeal Dysfunction

【目的】超声引导环咽肌A型肉毒毒素靶点注射治疗脑干梗死后环咽肌功能障碍的安全性和可行性初探,为环咽肌功能障碍提供更实用、方便的治疗方法。【方法】脑桥延髓交界处右侧亚急性腔隙性脑梗塞后吞咽障碍患者,经吞咽造影检查,确诊为环咽肌开放不完全。采用超声+球囊进行精准定位,采用平面外成像技术对左侧环咽肌进行A型肉毒毒素25 U/0.8 mL注射。【结果】注射后患者吞咽功能明显改善,注射后第5天可进食粥,第8天可进食烂饭及小口喝水。注射后2周复查吞咽造影:食团可顺利通过食管入口,流线无明显变细或中断,无咽部残留,提示环咽肌正常开放。【结论】超声引导对环咽肌进行肉毒毒素注射是安全且可行的,操作方便,但需在以后临床中积累更多病例资料来进一步证明。

【Objective】To investigate the feasibility and effectiveness of using ultrasound-guided cricopharyngeal（CP）botulinum toxin（BTX）injection to treat cricopharyngeal dysfunction after brainstem infarction.【Method】A patient with dysphagia caused by subacute lacunar infarction in the right pontobulbar junction was diagnosed with incomplete opening of cricopharyngeal muscle by videofluoroscopic swallowing study（VFSS）. After precisely locating the CP muscle with catheter balloon and ultrasound,we injected BTX（25 U/0.8 mL）into the left CP muscle using the out-of-plane approach technique.【Result】After the injection,the patient made great progress in swallowing. He was able to eat porridge independently without bucking on the 5 th day,while soft rice on the 8 th day and sip water. Two weeks after the injection,VFSS showed that the bolus progressed into the esophagus fluently without the route getting narrow or broken off,and hardly found residue in pharynx,which suggested that the CP muscle could open properly.【Conclusion】Cricopharyngeal injection of BTX guided by ultrasound is a safe and effective way to treat cricopharyngeal dysfunction after brainstem infarction,which is also convenient to operate and deserves to be disseminated after the further studies proves its effectiveness.