球囊扩张术治疗脑干病变后环咽肌失弛缓症的疗效研究  

Efficacy of balloon dilatation therapy for cricopharyngeal achalasia in patients with brainstem lesions

作　　者：兰月[1] 窦祖林[1] 万桂芳[1] 李鑫[1] 

机构地区：[1]广州中山大学附属第三医院康复医学科,广州510630

出　　处：《中华物理医学与康复杂志》2009年第12期835-838,共4页Chinese Journal of Physical Medicine and Rehabilitation

基　　金：基金项目：国家十一五科技支撑计划项目子课题（2006BA101A14）,广东省卫生厅项目（B2007059）

摘　　要：目的 观察创新性球囊扩张术对脑干病变后环咽肌失弛缓症所致吞咽障碍的治疗作用。方法30例脑干病变后吞咽障碍患者，经吞咽造影诊断为环咽肌失弛缓症，分为治疗组与对照组。治疗组给予球囊扩张术及常规吞咽康复训练，对照组仅给予常规吞咽康复训练，治疗终点为恢复经口进食或治疗已满4周。分别在治疗前、治疗终点采用视频吞咽造影检查、进食功能评价进行测评。结果治疗组患者经球囊扩张术治疗10～24次后，15例患者巾有12例进食功能改善，对照组仅7例进食功能有改善，2组差异有统计学意义（P〈0．05）。治疗前、后视频吞咽造影检查分析发现，治疗组12例环咽肌开放情况改善，而对照组中仅7例有所改善，2组差异有统计学意义（P〈0．05）；视频吞咽造影检查中咽通过时间比较，治疗组中治疗前平均0．23s，治疗后为0．15s，差异有统计学意义（P〈0．05）。结论球囊扩张术对脑干病变后环咽肌失弛缓症所致吞咽障碍疗效显著，可明显改善咽期及食管期症状。Objective To investigate the effects of using a catheter balloon to treat cricopharyngeal achaiasia in patients with brainstem lesions. Methods Thirty cases of dysphagia caused by brainstem lesions were diagnosed as cricopharyngeal achalasia through videofluoroseopy of swallowing. The cases were divided into a treatment group and a control group randomly. The treatment group was treated with balloon dilatation and routine dysphagia rehabilitation training once daily, while the control group was treated with routine dysphagia rehabilitation training only. The treatment end point was either the patient resuming an oral diet or after 4 weeks of treatment. All cases were evaluated videofluoroscopically with a drinking test pre- and post- treatment. Results After 10 to 24 balloon dilatations, 10 of the 15 patients in the treatment group regained the ability to take solid food and water orally, though 2 of them could take pasty food only. Only 2 of the 15 patients in the control group regained the ability to take common food by mouth, though 5 of them could take pasty food. The other patients had no improvement. There was a significant difference between the two groups. The cricopharyngeal achalasia of 12 patients in the treatment group improved from incomplete relaxation/opening to complete relaxation/opening. Pooling and residue in the pyriform sinus or valleculae was reduced and no misaspiration was observed. In the control group only 7 patients had some improvement. The mean time for the bolus passing the pharynx after treatment was significantly shortened from 0. 23 s to 0. 15 s in the treatment group, but not significantly in the control group. Conclusions Catheter balloon dilatation is effective for cricopharyngeal achalasia caused by brainstem injury and is helpful for relieving the symptoms in the pharynx phase and the esophagus phase of dysphagia.

关 键 词：环咽肌失弛缓症 吞咽障碍 视频吞咽造影检查 球囊扩张术 

分 类 号：R741[医药卫生—神经病学与精神病学] R766[医药卫生—临床医学]