Wataganara T, Leelakusolvong S, Sunsaneevithayakul P, Vantanasiri C
Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Faculty of Medicine Siriraj Hospital, Bangkok, Thailand.
J Perinatol. 2009 Sep;29(9):637-9. doi: 10.1038/jp.2009.65.
A pregnant Thai woman presented with progressive dysphagia starting from the gestational age of 18 weeks. Total parenteral nutrition was administered at 33 weeks of gestation due to severe malnutrition. The fetus was found to be growth restricted. Preliminary diagnosis was esophageal achalasia. Diagnostic and treatment options, including early delivery followed by surgical intervention, temporizing pneumatic dilation and intrasphincteric botulinum toxin injection, were discussed before endoscopic examination. The patient preferred temporizing treatments to prolong the pregnancy and to allow for an improvement of her nutritional status to facilitate postpartum recovery. Marked dilatation of the esophagus was found during esophagoscopy. Therefore, local injection of 80 U of botulinum toxin A was chosen over balloon dilation. The swallowing function improved soon after the treatment. The patient and the fetus started to gain weight. Subsequent sonographic examinations did not show any evidence of botulinum toxicity in the fetus. The baby was born at 36 weeks of gestation with an active respiration and preserved muscle tones. Breast-feeding was withheld. The patient remained asymptomatic for at least 6 weeks after delivery. There have been reports of an intentional use of botulinum toxin in selected cases of unremitting movement disorder during pregnancy. No deleterious effects to the mothers or the babies were found in local injection with limited dosage after the first trimester. The authors cannot encourage the routine administration of this neurotoxin for the treatment of achalasia during pregnancy. However, this report provides additional information of botulinum toxin use in pregnant women.
一名泰国孕妇自孕18周起出现进行性吞咽困难。由于严重营养不良，在孕33周时给予了全胃肠外营养。发现胎儿生长受限。初步诊断为贲门失弛缓症。在内镜检查前，讨论了诊断和治疗方案，包括早产然后进行手术干预、临时气囊扩张和括约肌内注射肉毒杆菌毒素。患者更倾向于采取临时治疗措施以延长孕期，并改善其营养状况以利于产后恢复。食管镜检查时发现食管明显扩张。因此，选择局部注射80单位A型肉毒杆菌毒素而非气囊扩张。治疗后吞咽功能很快得到改善。患者和胎儿体重开始增加。随后的超声检查未显示胎儿有任何肉毒杆菌毒素中毒的迹象。婴儿在孕36周时出生，呼吸活跃，肌张力正常。停止母乳喂养。患者产后至少6周无症状。有报道称在孕期某些持续性运动障碍的特定病例中有意使用肉毒杆菌毒素。孕早期后局部注射有限剂量未发现对母亲或婴儿有有害影响。作者不鼓励在孕期常规使用这种神经毒素治疗贲门失弛缓症。然而，本报告提供了孕妇使用肉毒杆菌毒素的更多信息。
