消化内镜引导下肉毒毒素注射联合球囊扩张治疗脑干梗死后环咽肌失弛缓的效果

Endoscopic botulinum toxin injection combined with balloon dilatation for treatment of cricopharyngeal achalasia in patient with brainstem stroke

目的:目前国内已有超声、肌电或CT引导下环咽肌A型肉毒毒素(botulinum toxin Type A,BTX-A)注射治疗环咽肌失迟缓的研究,但鲜见内镜引导下环咽肌BTX-A注射的研究报道。本研究拟探讨消化内镜引导下BTX-A注射联合球囊扩张治疗脑干梗死后环咽肌失弛缓的疗效,为脑干梗死后吞咽障碍治疗提供一种更好的治疗方法。方法:选择2022年6月至12月长沙市第一医院康复医学科收治的脑干梗死环咽肌失迟缓患者30例,随机分为对照组与联合组,每组15例。2组患者均进行常规康复治疗,对照组行球囊扩张治疗,联合组行球囊扩张治疗和环咽肌BTX-A注射治疗。于治疗前和治疗2周后行吞咽造影检查,采用渗漏/误吸量表(Penetration-aspiration Scale,PAS)、吞咽障碍结局与严重度量表(Dysphagia Outcome Severity Scale,DOSS)、功能性经口摄食量表(Functional Oral Intake Scale,FOIS)评估患者的吞咽功能。结果:联合组有1例患者因个人原因自行退出。治疗2周后,2组DOSS评分、PAS评分、FOIS分级均优于治疗前(均P<0.01),且联合组均优于对照组(均P<0.001)。联合组的治疗有效率为85.7%,对照组有效率为66.7%,2组比较差异无统计学意义(P>0.05)。结论:环咽肌BTX-A注射联合球囊扩张较单独使用球囊扩张对改善吞咽功能效果更好,值得临床推广应用。

Objective:At present,there are many reports about the treatment of cricopharyngeal achalasia by injecting botulinum toxin type A(BTX-A)into cricopharyngeal muscle guided by ultrasound,electromyography or CT in China,but there is no report about injecting BTX-A into cricopharyngeal muscle guided by endoscope.This study aims to evaluate the efficacy of endoscopic BTX-A injection combined with balloon dilatation in the treatment of cricopharyngeal achalasia after brainstem stroke,and to provide a better method for the treatment of dysphagia after brainstem stroke.Methods:From June to December 2022,30 patients with cricopharyngeal achalasia due to brainstem stroke were selected from the Department of Rehabilitation Medicine,the First Hospital of Changsha.They were randomly assigned into a control group and a combined group,15 patients in each group.Patients in both groups were treated with routine rehabilitation therapy,while patients in the control group were treated with balloon dilatation,and patients in the combined group were treated with balloon dilatation and BTX-A injection.Before treatment and after 2 weeks of treatment,the patients were examined by video fluoroscopic swallowing study,Penetration-aspiration Scale(PAS),Dysphagia Outcome Severity Scale(DOSS),and Functional Oral Intake Scale(FOIS)were used to assess the swallowing function.Results:In the combined group,1 patient withdrew from the treatment because of personal reasons.Two weeks after treatment,the scores of DOSS,PAS,and FOIS in both groups were better than those before treatment(all P<0.01),and the combined group was better than the control group(all P<0.001).The effective rate was 85.7%in the combined group and 66.7%in the control group,with no significant difference between the 2 groups(P>0.05).Conclusion:BTX-A injection combined with balloon dilatation is more effective than balloon dilatation alone in improving swallowing function and is worthy of clinical application.