内镜下水囊扩张和肉毒毒素注射治疗贲门失弛缓症的疗效比较  

Endoscopic water-filled balloon dilatation and botulinum toxin injection for treatment of achalasia: a comparison of clinical effectiveness

作　　者：周慧[1] 戴彦苗 陆伦根[1] 罗声政[1] 钱月琴[1] 宛新建[1] 

机构地区：[1]上海交通大学医学院附属第一人民医院消化内科,上海200080 [2]江苏省昆山市中医医院脾胃肝胆科,苏州215300

出　　处：《第二军医大学学报》2012年第9期1001-1005,共5页Academic Journal of Second Military Medical University

摘　　要：目的评估贲门失弛缓症患者的食管动力学和临床症状,对比内镜下水囊扩张及肉毒毒素注射两种方法的疗效。方法采用前瞻性随机对照研究方法,选取临床初次确诊为原发性贲门失弛缓症的患者共80例,随机分为2组,分别接受内镜下水囊扩张和肉毒毒素注射治疗。记录患者治疗前及治疗后1周、1个月的临床症状评分和食管动力学指标,并记录随访12个月内患者的缓解率情况。结果两组患者治疗后1周、1个月的临床症状积分(总体症状、反食、吞咽困难、胸痛)和食管动力学指标(下食管括约肌静息压和松弛率、食管体部收缩幅度及顺行性收缩百分比)较治疗前均有改善(P<0.01)。治疗后1周水囊扩张组反食、吞咽困难症状积分的改善优于肉毒毒素注射组(P<0.05,P<0.01),治疗后1周和1个月水囊扩张组下食管括约肌静息压的改善优于肉毒毒素注射组(P<0.01)。术后12个月水囊扩张组和肉毒毒素注射组临床缓解率分别为73.2%和61.5%,Kaplan-Meier法分析显示术后12个月两组累积缓解率差异无统计学意义(P=0.29)。结论内镜下水囊扩张和肉毒毒素注射两种方法治疗贲门失弛缓症均有效,而且前者的治疗效果更好。Objective To compare the curative effects of water-filled balloon dilatation and botulinum toxin local injection in treatment of achalasia by evaluating the clinical symptoms and esophageal kinematics. Methods Eighty patients diagnosed as primary achalasia were randomly assigned to endoscopic water-filled balloon dilatation group and botulinum toxin group in a prospective randomized controlled trial. The clinical symptoms and esophageal kinematics of patients were evaluated before and 1 week, 1 month after therapy, and the data of remission were recorded during a follow-up of 24 months. Results The clinical symptom scores （overall symptom, regurgitation of food, dysphagia and chest pain） and esophageal kinematics （the lower esophageal sphincter resting pressure and relaxation rate of lower esophageal sphincter, contracting amplitude of esophageal body and the percentage of esophageal body antegrade peristalsis） were significantly improved in both treatment groups 1 week and 1 month after therapy （P〈0.01） . One week after treatment the improvements in regurgitation and dysphagia scores were greater in water-filled balloon group than those in the botulinum toxin group （P^0.05, P^0.01）. The reduction in lower esophageal sphincter resting pressure was greater in water-filled balloon group than that in the botulinum toxin group 1 week and 1 month after treatment （P〈0. 01）. After 12 months, the clinical remission rates in water-filled balloon group and botulinum toxin group were 73.2 %and 61.5%, respectively; Kapian-Meier analysis demonstrated no significant difference in the accumulated remission rates between the 2 groups（P=0. 29）. Conclusion Both endoscopic water-filled balloon dilatation under endoscope and botulinum toxin local injection are effective for treatment of achalasia, with better therapeutic effect seen for water-filled balloon dilatation.

关 键 词：贲门失弛缓症 水囊扩张 肉毒毒素类 食管动力学 

分 类 号：R571.4[医药卫生—消化系统]