局部注射A型肉毒杆菌毒素治疗贲门失弛缓症临床疗效观察

目的:探讨局部注射A型肉毒杆菌毒素(BTA)治疗贲门失弛缓症的近期和远期临床疗效。方法:选择原发性贲门失弛缓症(PA)患者248例和假性贲门失弛缓症(SA)患者11例,内镜下在食管痉挛处注射BTA20IU,根据治疗前、后的临床症状缓解情况判定其疗效。结果:治疗1周后,所有PA患者的临床症状均有明显的缓解(100.0%),显著高于SA患者(18.2%)(P<0.001);PA患者治疗1、3、6个月的临床症状缓解总有效率达到91.5%、87.2%、77.0%,但治疗1、3、5、10年后总有效率只有51.1%、56.3%、49.0%、44.1%,长期疗效显著低于短期疗效(P<0.01)。结论:局部注射BTA治疗贲门失弛缓症的近期疗效较好,对PA和SA的鉴别也有一定价值。

Clinical Efficacy Observation on Local Injection of Botulinum Toxin Type A in the Treatment of Achalasia

OBJECTIVE：To evaluate the short-term and long-term clinical efficacy of local injection of botulinum toxin type A（BTA）in the treatment of achalasia.METHODS：248 patients with primary achalasia（PA）and 11 patients with pseudo achalasia（SA）were enrolled.Twenty units BTA diluted with normal saline were endoscopically injected into spasmodic esophageal cardia.The clinical efficacy was evaluated with scores of clinical symptoms.RESULTS：The rate of symptom relief in all PA patients treated with BTA injection was 100.0%,which was absolutely higher than 18.2% in SA patients（P0.001）.The total response rate in PA patients were 91.5% for one month of treatment,87.2% for three months of treatment and 77.0% for six months of treatment,which were all significantly higher than these total response rate,including 51.1% for 1 year of treatment,56.3% for 3 years of treatment,49.0% for 5 years of treatment and 44.1% for 10 years of treatmen（tP0.01）.CONCLUSION：Local injection of BTA has sound short-term efficacy in the treatment of primary achalasia and is a valuable method for the identification between primary achalasia and pseudo achalasia.