Barnes Melynda A, Ho Allen S, Malhotra Prashant S, Koltai Peter J, Messner Anna
Division of Pediatric Otolaryngology, Department of Otolaryngology-Head and Neck Surgery, Lucile Packard Children's Hospital, Stanford University School of Medicine, 801 Welch Road, Stanford, CA 94305, United States.
Int J Pediatr Otorhinolaryngol. 2011 Sep;75(9):1210-4. doi: 10.1016/j.ijporl.2011.07.022.
Cricopharyngeal achalasia is an uncommon cause of feeding difficulties in the pediatric population, and is especially rare in infants. Traditional management options include dilation or open cricopharyngeal myotomy. The use of botulinum toxin has been preliminarily reported for cricopharyngeal achalasia in children as a modality for diagnosis and management. This study describes the use of botulinum toxin as a definitive treatment for pediatric cricopharyngeal achalasia.
A retrospective analysis was performed of three patients who were diagnosed with cricopharyngeal achalasia and underwent botulinum toxin injections to the cricopharyngeus muscle. The charts were reviewed for etiology, botulinum toxin dosage delivered, length of follow-up, postoperative need for nasogastric tube placement, and swallow studies.
A total of 7 botulinum toxin injections into the cricopharyngeus muscle were performed in three infants with primary cricopharyngeal achalasia between April 2006 and February 2011. Mean dosage was 23.4 units per session (range: 10-44 units), or 3.1 U/kg (range: 1.4-5.3 U/kg). Mean interval period between injections was 3.3 months (range: 2.7-4.0 months). Mean follow-up period was 22.1 months (range: 3.4-44.5 months). One patient required hospital readmission after injection for presumed aspiration but recovered without need for surgical intervention. No long-term complications were noted post-operatively. All patients improved clinically and ultimately had their nasogastric feeding tubes removed.
Botulinum toxin appears to be a safe and effective option in the management of primary cricopharyngeal achalasia in children, and may prevent the need for myotomy.
环咽肌失弛缓症是小儿喂养困难的一种罕见病因，在婴儿中尤为少见。传统的治疗方法包括扩张术或开放性环咽肌切开术。肉毒杆菌毒素已被初步报道可用于小儿环咽肌失弛缓症的诊断和治疗。本研究描述了肉毒杆菌毒素作为小儿环咽肌失弛缓症的确定性治疗方法的应用情况。
对3例诊断为环咽肌失弛缓症并接受肉毒杆菌毒素注射至环咽肌的患者进行回顾性分析。查阅病历以了解病因、注射的肉毒杆菌毒素剂量、随访时间、术后鼻胃管放置需求及吞咽研究情况。
2006年4月至2011年2月期间，对3例原发性环咽肌失弛缓症婴儿共进行了7次环咽肌肉毒杆菌毒素注射。平均每次剂量为23.4单位（范围：10 - 44单位），或3.1 U/kg（范围：1.4 - 5.3 U/kg）。注射间隔平均为3.3个月（范围：2.7 - 4.0个月）。平均随访期为22.1个月（范围：3.4 - 44.5个月）。1例患者注射后因疑似误吸需再次入院，但无需手术干预即康复。术后未发现长期并发症。所有患者临床症状均有改善，最终拔除了鼻胃饲管。
肉毒杆菌毒素似乎是治疗小儿原发性环咽肌失弛缓症的一种安全有效的方法，且可能避免进行肌切开术。
