经内镜肉毒毒素注射联合球囊扩张治疗脑梗死并发环咽肌失弛缓症。
Endoscopic botulinum toxin injection combined with balloon dilatation for treatment of cricopharyngeal achalasia in patient with brainstem stroke.
机构信息
Department of Rehabilitation Medicine, First Hospital of Changsha, Changsha 410005.
Department of Gastroenterology, First Hospital of Changsha, Changsha 410005, China.
出版信息
Zhong Nan Da Xue Xue Bao Yi Xue Ban. 2023 Aug 28;48(8):1203-1209. doi: 10.11817/j.issn.1672-7347.2023.230254.
OBJECTIVES
At present, there are many reports about the treatment of cricopharyngeal achalasia by injecting botulinum toxin type A (BTX-A) into cricopharyngeal muscle guided by ultrasound, electromyography or CT in China, but there is no report about injecting BTX-A into cricopharyngeal muscle guided by endoscope. This study aims to evaluate the efficacy of endoscopic BTX-A injection combined with balloon dilatation in the treatment of cricopharyngeal achalasia after brainstem stroke, and to provide a better method for the treatment of dysphagia after brainstem stroke.
METHODS
From June to December 2022, 30 patients with cricopharyngeal achalasia due to brainstem stroke were selected from the Department of Rehabilitation Medicine, the First Hospital of Changsha. They were randomly assigned into a control group and a combined group, 15 patients in each group. Patients in both groups were treated with routine rehabilitation therapy, while patients in the control group were treated with balloon dilatation, and patients in the combined group were treated with balloon dilatation and BTX-A injection. Before treatment and after 2 weeks of treatment, the patients were examined by video fluoroscopic swallowing study, Penetration-aspiration Scale (PAS), Dysphagia Outcome Severity Scale (DOSS), and Functional Oral Intake Scale (FOIS) were used to assess the swallowing function.
RESULTS
In the combined group, 1 patient withdrew from the treatment because of personal reasons. Two weeks after treatment, the scores of DOSS, PAS, and FOIS in both groups were better than those before treatment (all <0.01), and the combined group was better than the control group (all <0.001). The effective rate was 85.7% in the combined group and 66.7% in the control group, with no significant difference between the 2 groups (>0.05).
CONCLUSIONS
BTX-A injection combined with balloon dilatation is more effective than balloon dilatation alone in improving swallowing function and is worthy of clinical application.
目的
目前，国内有许多关于超声、肌电图或 CT 引导下经口内镜注射肉毒毒素 A（BTX-A）治疗环咽肌失弛缓症的报道，但尚无内镜引导下经口环咽肌注射 BTX-A 的报道。本研究旨在评估内镜下 BTX-A 注射联合球囊扩张治疗脑梗死后环咽肌失弛缓症的疗效，为脑梗死后吞咽障碍的治疗提供更好的方法。
方法
选取 2022 年 6 月至 12 月在长沙市第一医院康复医学科就诊的 30 例脑梗死所致环咽肌失弛缓症患者，采用随机数字表法分为对照组和联合组，每组 15 例。两组患者均给予常规康复治疗，对照组患者给予球囊扩张治疗，联合组患者给予球囊扩张联合 BTX-A 注射治疗。治疗前及治疗 2 周后，两组患者均行视频透视吞咽造影检查，采用吞咽障碍严重程度评分（PAS）、吞咽障碍结局量表（DOSS）、功能性经口摄食量表（FOIS）评估吞咽功能。
结果
联合组 1 例患者因个人原因退出治疗。治疗 2 周后，两组患者的 DOSS、PAS、FOIS 评分均优于治疗前（均<0.01），且联合组优于对照组（均<0.001）。联合组的有效率为 85.7%，对照组为 66.7%，两组比较差异无统计学意义（>0.05）。
结论
BTX-A 注射联合球囊扩张治疗较单纯球囊扩张治疗能更有效地改善吞咽功能，具有临床应用价值。
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