Murry Thomas, Wasserman Tamara, Carrau Ricardo L, Castillo Beatriz
Department of Otolaryngology, College of Physicians and Surgeons, Columbia University, New York, NY, USA.
Am J Otolaryngol. 2005 May-Jun;26(3):157-62. doi: 10.1016/j.amjoto.2004.11.010.
The objective was to evaluate changes in swallow safety and dietary status after the transcutaneous injection of botulinum toxin A into the upper esophageal sphincter in a series of outpatients with dysphagia.
This was an experimental, prospective, nonrandomized study.
Patients who were at risk for aspiration and who had an unsuccessful trial of swallowing therapy were admitted to the study. All patients showed significant pooling of fluids in the postcricoid region. All patients were treated in the office; none had previous esophageal dilatation. The upper border of the cricoid cartilage was identified using standard electromyogram procedures and 100 U of botulinum toxin (Botox A) were injected. Outcomes were assessed using the penetration-aspiration scale, patients' short-term and long-term subjective impressions of their ability to swallow, and change in dietary status.
Thirteen patients underwent an instrumental evaluation of swallowing function at approximately 6 months after treatment to corroborate the self-reported changes in swallowing. Of the 13 patients, 12 showed an overall improvement in their ability to take an oral diet safely as evidenced by the penetration-aspiration scale. Of the 12 patients who were on a non-oral or nearly non-oral diet, 9 resumed a normal oral diet. The remaining 3 were on an oral diet supplemented by percutaneous endoscopic gastrostomy feeding. One patient remained on a non-oral diet.
Injection of Botox A in the office with no additional treatments resulted in a long-term increase in swallow safety, a reduction of penetration and/or aspiration, and a reduced need for non-oral feeding. Injection of Botox A in the office should be considered when there is failure of the cricopharyngeus muscle to relax after the swallow, significant pooling in the cricopharyngeal region, and a risk for penetration and aspiration.
本研究旨在评估经皮向上食管括约肌注射A型肉毒杆菌毒素后，一系列吞咽困难门诊患者吞咽安全性和饮食状况的变化。
这是一项实验性、前瞻性、非随机研究。
纳入有误吸风险且吞咽治疗试验未成功的患者。所有患者环状软骨后区域均有明显的液体潴留。所有患者均在门诊接受治疗，此前均未进行过食管扩张。使用标准肌电图程序确定环状软骨的上边界，并注射100 U肉毒杆菌毒素（保妥适A）。使用渗透-误吸量表、患者对吞咽能力的短期和长期主观感受以及饮食状况变化来评估结果。
13例患者在治疗后约6个月接受了吞咽功能的仪器评估，以证实自我报告的吞咽变化。在这13例患者中，12例经渗透-误吸量表评估显示其安全经口进食的能力总体有所改善。在12例非经口或几乎非经口饮食的患者中，9例恢复了正常经口饮食。其余3例为经皮内镜下胃造口术喂养补充经口饮食。1例患者仍为非经口饮食。
在门诊注射保妥适A且不进行其他治疗可使吞咽安全性长期提高，减少渗透和/或误吸，并减少非经口喂养的需求。当吞咽后环咽肌不能松弛、环咽区域有明显液体潴留以及存在渗透和误吸风险时，应考虑在门诊注射保妥适A。
