Kolbasnik J, Waterfall W E, Fachnie B, Chen Y, Tougas G
Department of Surgery, McMaster University, Hamilton, Ontario, Canada.
Am J Gastroenterol. 1999 Dec;94(12):3434-9. doi: 10.1111/j.1572-0241.1999.01605.x.
We sought to examine the long-term efficacy of intrasphincteric Botulinum toxin A injection in a prospective cohort study of 30 patients with achalasia.
Thirty patients with classical achalasia were treated with intrasphincteric Botulinum toxin A injection. Follow-up consisted of clinical assessment, symptom scoring, and postinjection manometry.
Symptomatic improvement for >3 months was seen in 23 of 30 patients (77%). Of the 23 initial responders, seven (30%) experienced a sustained symptomatic response after a single Botulinum toxin injection (mean follow-up, 21 months). The remaining 16 initial responders (70%) eventually relapsed (mean initial response, 11 months). Nine received a 2nd Botulinum toxin injection, and seven experienced an ongoing response (mean duration, 9 months); two patients eventually required a 3rd injection with good effect (mean duration, 22 months). The remaining seven patients who relapsed after Botulinum toxin opted for pneumatic dilation or surgical myotomy. Five of the seven patients who had no initial response received a 2nd injection but again did not respond. A residual lower esophageal sphincter pressure <18 mm Hg after the first Botulinum toxin injection predicted a good response to Botulinum therapy (single or multiple injections, p < 0.002, positive predictive value = 0.71, negative predictive value = 1.0). Neither initial nor sustained response to Botulinum toxin could be predicted based on gender, age, duration of illness, previous pneumatic dilation, or esophageal motility before treatment.
We found that 77% of patients with classical achalasia experienced a good symptomatic response after Botulinum toxin and 30% of initial responders achieve sustained symptomatic relief after a single treatment with Botulinum toxin. The initial responders who relapsed did well with subsequent Botulinum toxin A. Lack of an initial symptomatic response and residual lower esophageal sphincter pressure > or =18 mm Hg after Botulinum toxin are associated with a poor response.
我们试图在一项对30例贲门失弛缓症患者的前瞻性队列研究中，检验括约肌内注射A型肉毒杆菌毒素的长期疗效。
对30例典型贲门失弛缓症患者进行括约肌内注射A型肉毒杆菌毒素治疗。随访包括临床评估、症状评分和注射后测压。
30例患者中有23例（77%）症状改善持续超过3个月。在最初有反应的23例患者中，7例（30%）在单次注射肉毒杆菌毒素后有持续的症状缓解（平均随访21个月）。其余16例最初有反应的患者（70%）最终复发（平均初始反应持续11个月）。9例接受了第二次肉毒杆菌毒素注射，7例有持续反应（平均持续时间9个月）；2例患者最终需要第三次注射且效果良好（平均持续时间22个月）。其余7例肉毒杆菌毒素注射后复发的患者选择了气囊扩张术或手术肌切开术。7例最初无反应的患者中有5例接受了第二次注射，但仍无反应。首次注射肉毒杆菌毒素后残余食管下括约肌压力<18 mmHg预示着对肉毒杆菌毒素治疗反应良好（单次或多次注射，p<0.002，阳性预测值=0.71，阴性预测值=1.0）。根据性别、年龄、病程、既往气囊扩张或治疗前食管动力，均无法预测对肉毒杆菌毒素的初始或持续反应。
我们发现，77%的典型贲门失弛缓症患者在注射肉毒杆菌毒素后有良好的症状反应，30%的初始有反应者在单次注射肉毒杆菌毒素后实现了持续的症状缓解。复发的初始有反应者在随后的A型肉毒杆菌毒素治疗中效果良好。肉毒杆菌毒素注射后缺乏初始症状反应以及残余食管下括约肌压力≥18 mmHg与反应不佳相关。
