气囊扩张与肉毒毒素注射联合治疗贲门失弛缓症的临床研究

目的：比较单纯小气囊扩张、单纯肉毒毒素(BT)注射和两者联合治疗贲门失弛缓症的疗效与副作用。方法：48例患者随机被分为3组：扩张组只用小气囊扩张治疗；注射组只注射BT治疗；联合组两种方法联合应用。分别于术前，治疗后1周、3个月和1年时比较3组患者的临床症状积分(有效率)、下食管括约肌的压力(LESP)、松弛率(LESRR)。结果：在治疗后1周、3个月和1年时，有效率及治疗前后LESP和LESRR的差值，联合组和注射组该3项指标均高于扩张组；在治疗后l周和3个月时，联合组与注射组相比无明显差异；但1年时，联合组高于注射组。3组均无并发症发生。结论：小气囊扩张术与下食管括约肌内注射BT联合治疗贲门失弛缓症，具有疗效高、持续时间长、患者痛苦小等优点。值得临床上推广应用。

Clinical study on intrasphincteric injection of botulinum toxin and/or small balloon dilation in patients with esophageal achalasia

Objective To compare the effectiveness and adverse effects among three groups of patients with esophageal achalasia treated with small balloon dilation and/or intrasphincteric injection of botulinum toxin. Methods Forty-eight patients were divided randomly into three groups, A, B, and C, treated with small balloon dilation, intrasphincteric injection of botulinum toxin, and combination of these two respectively. At 1 week, 3 months and 1 year after treatment, the clinical scores, lower oesophageal sphincter-ic pressure, and lower oesophageal sphincteric relax rate in three groups were compared. Results At 1 week, 3 months and 1 year after treatment, the effective rates and gaps of pre - and post - treatment LESP and LESRR were higher in group B and C than those in group A. There were no differences between BT group and combination group at 1 week and 3 months, but in 1 year after treatment the effective rates and gaps of LESP and LESRR in combination group were higher than those in BT group. Complications never happened in all groups. Conclusion The combination of small balloon dilation and intrasphincteric injection of botulinum toxin was the effective procedure with the advantages of lasting longer time, less complications and milder chest pain.