内镜下经口环咽肌切除术治疗脑卒中后持续性吞咽障碍  

Laryngeal endoscopic cricopharyngeal myotomy for cricopharyngeal achalasia post stroke

作　　者：王剑[1] 李五一[1] 李永金[1] 杨大海[1] 霍红[1] 金晓峰[1] 牛燕燕[1] 田旭[1] 张竹花[1] 陈钰[1] 高志强[1] 

机构地区：[1]中国医学科学院北京协和医学院 北京协和医院耳鼻咽喉科,100730

出　　处：《中华耳鼻咽喉头颈外科杂志》2017年第10期729-732,共4页Chinese Journal of Otorhinolaryngology Head and Neck Surgery

摘　　要：目的探索经口内镜下结合低温等离子系统或新型微电力系统，治疗脑卒中后环咽肌失弛缓导致持续性吞咽障碍的手术有效性和安全性。方法回顾性分析7例内镜经口环咽肌切除和12例经颈部环咽肌切除病例的手术前后吞咽功能评估结果及手术并发症等相关资料。结果采用SPSS 17.0软件进行统计学分析。结果内镜组术后5例吞咽功能得到显著改善，经颈部手术组9例亦有显著改善。内镜组术前吞咽造影（video fluoroscopic swallowing study，VFSS）吞咽困难、误吸及洼田饮水试验评分分别为（6.1±0.7）分、（6.4±1.3）分和（4.6±0.5）分，术后评分分别为（3.1±1.1）分、（3.4±0.8）分和（2.0±0.6）分，手术前后评分差异有统计学意义（t＝6.874，t＝7.937，t＝12.728，P值均为0.000）。经颈部手术组术前VFSS吞咽困难、误吸及洼田饮水试验评分分别为（6.3±0.7）分、（7.2±0.9）分和（4.8±0.4）分，术后评分分别为（3.4±1.4）分（3.0±0.9）分和（2.2±0.6）分，手术前后差异有统计学意义（t＝9.324，t＝9.840，t＝14.182，P值均为0.000）。内镜组与经颈部手术组术后各项评分之间差异无统计学意义（t＝－0.435，t＝1.086，t＝－0.607，P均〉0.05）。术后仅内镜组出现1例颈部皮下气肿，经过保守治疗后自行恢复；均未出现伤口感染、颈深间隙、纵隔感染及新发脑卒中等严重并发症。结论经口内镜下环咽肌切除术对于脑卒中后因环咽肌失弛缓而持续吞咽障碍的患者具有较好的治疗效果和安全性。内镜结合低温等离子系统或新型微电刀系统，为今后开展咽喉部内镜手术提供了新的选择，成本低廉，更适合国内基层医院特点。ObjectiveTo explore the safety and validity of endoscopic cricopharyngeal myotomy in patients with cricopharyngeal achalasia.MethodsA total of 19 patients with cricopharyngeal achalasia suffered from sustained dysphagia were enrolled in this study. The patients were divided into transcervical cricopharyngeal myotomy（CPM） group and endoscopic CPM （ECPM） group. Swallowing function and complications were evaluated.SPSS7.0 software was used to analyze the data.ResultsThe swallowing function improved significantly in seven patients in ECPM group, and 9 patients improved in CPM group.The video fluoroscopic swallowing study（VFSS）-swallowing score, VFSS-aspiration score and drinking test score were （3.1±1.1）, （3.4±0.8） and （2.0±0.6）in post-ECPM, （3.4±1.4）, （3.0±0.9） and （2.2±0.6）in post-CPM. No statistical difference was found in validity between CPM group and ECPM group（t=-0.435, t=1.086, t=-0.607, P〉0.05）. No statistical difference was observed on the occurrence of complication between two groups. Only one patient had subcutaneous emphysema after operation in ECPM.ConclusionsNew surgical instruments and endoscopic surgical technique were safe and effective for cricopharyngeal achalasia. Because these instruments are cheaper, laryngeal endoscopic cricopharyngeal myotomy is easier to be popularized more easily than microscopic laser assistted CPM.

关 键 词：吞咽障碍 卒中 内窥镜检查 低温等离子 

分 类 号：R743.3[医药卫生—神经病学与精神病学]