逆行性环咽肌功能障碍的临床特征和内镜下A型肉毒素治疗  

Retrograde cricopharyngeal dysfunction: clinical characteristics and endoscopic treatment using botulinum toxin-A

作　　者：侯思源 李进让 王嘉森 鞠骏 Hou Siyuan;Li Jinrang;Wang Jiasen;Ju Jun(Department of Otolaryngology-Head and Neck Surgery,the Sixth Medical Centre of Chinese PLA General Hospital,Beijing 100048,China)

机构地区：[1]解放军总医院第六医学中心耳鼻咽喉头颈外科,北京100048

出　　处：《中华耳鼻咽喉头颈外科杂志》2025年第2期172-176,共5页Chinese Journal of Otorhinolaryngology Head and Neck Surgery

摘　　要：目的探讨逆行性环咽肌功能障碍(RCPD)的临床特点,以及肉毒素环咽肌注射术治疗RCPD的临床疗效和安全性。方法该病例系列研究纳入2024年2至11月解放军总医院第六医学中心耳鼻咽喉头颈外科的网上调查和门诊收治的22例RCPD患者[男15例,女7例,年龄14~34(25.0±5.2)岁],对其一般情况、临床表现、症状严重程度评分和相关检查进行总结和分析。对7例接受肉毒素环咽肌注射术患者的手术疗效和术后并发症进行分析。结果22例患者均自幼出现打嗝困难的症状,其次症状为颈部胸部咕噜声、腹胀、呕吐困难、恶心、颈部压迫感及咽喉部异物感等。所有症状中打嗝困难最为严重(症状严重程度评分4.8分)。7例患者接受全身麻醉支撑喉镜下环咽肌肉毒素注射术,术后6.0 d出现打嗝。中位随访5个月,患者打嗝困难的症状均完全缓解。7例患者术后均未出现声嘶、饮水呛咳和呼吸困难等并发症,1例出现咽喉反流和6例出现吞咽困难,分别于术后1周和术后24.8 d完全缓解。结论RCPD以不能打嗝为主要症状,环咽肌肉毒素注射术是安全且有效的治疗方法。ObjectivesThis study aims to investigate the features of retrograde cricopharyngeal dysfunction(RCPD)and to evaluate the effectiveness and safety of Botulinum toxin-A as a treatment for RCPD.MethodsTwenty-two RCPD patients admitted between February 2024 and November 2024 were included through online and offline methods in The Sixth Medical Centre of Chinese PLA General Hospital(15 males,7 females,age range,14-34 years;mean age 25.0±5.2 years).The general condition,symptoms,severity scores,and auxiliary examinations were summarized and analyzed.Operative results and postoperative complications of RCPD patients treated with Botulinum toxin-A were analyzed.ResultsAll patients could not burp since early childhood,followed by gurgling noises,abdominal flatulence,laryngopharyngeal foreign body sensation,and cervical constriction.The most severe symptom was the inability to burp with a mean score of 4.8.Seven patients who received botulinum toxin injections under the supporting laryngoscopes started burping six days post-operation.With a median follow-up of 5 months,all patients achieved the ability to belch.In none of these seven cases,intraoperative complications were noted including hoarseness,choking cough when drinking water,or dyspnea.One patient experienced laryngopharyngeal reflux and six patients had dysphagia,which were relieved at 1 week and 24.8 days postoperatively.ConclusionRCPD is a disease characterized by the inability to burp,cricopharyngeal muscle injection by Botulinum toxin-A is effective and safe.

关 键 词：肉毒杆菌毒素类 A型 逆行性环咽肌功能障碍 打嗝困难 

分 类 号：R47[医药卫生—护理学]