超声联合球囊引导下注射肉毒毒素治疗环咽肌失弛缓症的疗效观察

Combining ultrasound with balloon-guided injection of botulinum toxin in the treatment of cricopharyngeal achalasia

目的观察超声联合球囊引导下向食道上括约肌注射肉毒毒素治疗环咽肌失弛缓症患者的临床疗效。方法采用随机数字表法将40例环咽肌失弛缓症患者分为观察组及对照组,每组20例。2组患者均给予常规吞咽康复训练,观察组患者在此基础上辅以超声联合球囊引导下向食道上括约肌注射肉毒毒素,共注射1次。于治疗前、治疗后2周时对2组患者进行吞咽造影检查(VFSS)和软式喉内窥镜吞咽功能检查(FEES);于治疗前、治疗后2周、4周、24周时采用功能性经口摄食量表(FOIS)评估患者进食功能,采用渗漏误吸量表(PAS)评估患者渗漏、误吸程度,采用纤维内窥镜吞咽困难严重程度量表(FEDSS)、Murray分泌物潴留量表(MSS)评估患者口咽分泌物残留及清除情况。结果干预期间对照组无患者脱落,观察组有1例患者失访。治疗后2周时发现2组患者PAS、FEDSS及MSS评分均较治疗前明显改善(P<0.05),并且此时观察组PAS、FEDSS及MSS评分[分别为3(2,5)分,3(2,5)分和2(1,2)分]亦显著优于对照组水平(P<0.05)。治疗后2周、4周及24周时2组患者FOIS评分均较治疗前明显改善(P<0.05),并且上述时间点观察组FOIS评分[分别为3(2,4)分,4(2,6)分和6(3,7)分]亦显著优于对照组水平(P<0.05)。结论超声联合球囊引导下向食道上括约肌注射肉毒毒素能有效改善环咽肌失弛缓症患者的吞咽功能,且治疗安全性较好、远期疗效显著,该注射疗法值得临床推广、应用。

Objective To observe any clinical effect of supplementing ultrasound stimulation with balloon-guided injection of botulinum toxin into the upper esophageal sphincter in the treatment of cricopharyngeal achalasia.Methods Forty patients with cricopharyngeal achalasia were randomly divided into an observation group and a control group,each of 20.Both groups were given routine swallowing rehabilitation training,while the observation group additionally had botulinum toxin injected into the upper esophageal sphincter guided by ultrasound and with the aid of balloon dilation.Before the experiment and after 2 weeks,both groups were evaluated videofluoroscopically and flexible endoscopic evaluation of swallowing was performed.Moreover,2 weeks before the treatment and 2,4 and 24 weeks afterward,everyone′s eating,leakage and aspiration,and oral and pharyngeal secretions were assessed using the functional oral intake scale(FOIS),the penetration-aspiration scale(PAS),the fiberoptic endoscopic dysphagia severity scale(FEDSS)and the Murray secretion scale(MSS).Results After 2 weeks the average PAS,FEDSS and MSS scores of both groups had improved significantly,but the observation group′s averages[3(2,5),3(2,5)and 2(1,2)]were significantly better than those of the control group.2,4 and 24 weeks after the experiment the average FOIS scores of both groups also showed significant improvement,with the observation group′s average[3(2,4),4(2,6)and 6(3,7)]again significantly better than that of the control group.Conclusions A botulinum toxin injection into the upper esophageal sphincter can effectively improve the swallowing of persons with cricopharyngeal achalasia with adequate safety and significant long-term benefits.Therefore,such treatment is worthy of clinical promotion and application.