作为食管上括约肌(UES)功能障碍障碍,环咽贲门失弛缓症(CPA)是吞咽困难的常见原因,并与肺部并发症的风险增加有关。这项研究的目的是探讨使用超声结合球囊引导注射BTX-A治疗中风引起的CPA的有效性和安全性。
对21例诊断为CPA的患者进行了超声结合球囊引导的环咽肌BTX-A注射治疗。主要结果指标,包括功能性口服摄入量表(FOIS),透视下吞咽困难量表(VDS)和穿透抽吸量表(PAS),这是视频荧光透视吞咽研究(VFSS)的定量测量,从基线到治疗后12周,评估焦虑自评量表(SAS)和抑郁自评量表(SDS)的评分。重复测量方差分析用于比较时间点之间的得分。
BTX-A注射液改善了19例患者的吞咽困难症状和评分(90.48%)。其中,治愈5例(23.81%),11例明显改善(52.38%),改善3例(14.29%)。2例绝对无效(9.52%)。与治疗前的评分相比,FOIS上的分数,VDS,PAS,SAS和SDS在注射后3天开始显著改善(p<.05)并持续至少12周。
球囊引导BTX-A注射超声可能是相对安全的,easy,以及治疗中风引起的CPA的有效技术,具有更好的可视化注射程序。需要一个设计良好的对照试验,样本量更大,才能得出更有说服力的结论。
As an upper oesophageal sphincter (UES) dysfunction disorder, cricopharyngeal achalasia (CPA) is a common cause of dysphagia and is associated with an increased risk of pulmonary complications. The aim of this study was to investigate the effectiveness and safety of BTX-A injection using ultrasound combined with balloon guidance for the treatment of CPA caused by stroke.
A total of 21 patients diagnosed with CPA were treated with BTX-A injection into the cricopharyngeal muscle using ultrasound combined with balloon guidance. Primary outcome measures, including the functional oral intake scale (FOIS), videofluoroscopic dysphagia scale (VDS) and penetration aspiration scale (PAS), which are quantitative measures for a video fluoroscopic swallowing study (VFSS), and scores of the self-rating anxiety scale (SAS) and self-rating depression scale (SDS) were assessed from baseline to 12 weeks after treatment. Repeated measures analysis of variance was used to compare the scores between time points.
BTX-A injection led to improved dysphagia symptoms and scores in 19 patients (90.48%). Among them, 5 cases were cured (23.81%), 11 cases showed significant improvement (52.38%), and 3 cases showed improvement (14.29%). Two cases were absolutely ineffective (9.52%). Compared with the scores prior to treatment, the scores on the FOIS, VDS, PAS, SAS and SDS significantly improved beginning at 3 days (p < .05) and lasting for at least 12 weeks after injection.
Ultrasound with balloon-guided BTX-A injection is probably a relatively safe, easy, and effective technique for the treatment of CPA caused by stroke, with better visualization of the injection procedure. A well-designed controlled trial with a larger sample size is needed for more convincing conclusions.