气囊扩张联合肉毒毒素注射治疗贲门失弛缓症

目的探讨气囊扩张联合肉毒毒素局部注射治疗贲门失弛缓症的临床效果。方法贲门失弛缓症患者28例随机等分为扩张组和联合组，前者仅用气囊扩张治疗，后者接受气囊扩张治疗后，在内镜直视下食管括约肌（LES）内注射A型肉毒毒素治疗。术前、治疗后3、12和24个月随访观察两组患者的临床效果、下食管括约肌的压力（LESP）、松弛率（LESRR）及贲门口内径、5min存留钡柱高度等。结果在治疗后3个月时联合组与扩张组的临床效果相比差异无统计学意义（P〉0．05），但12和24个月时，联合组的临床效果高于扩张组；治疗前后LESP和LESRR的差值，联合组均高于扩张组；治疗后3个月贲门口直径、5min存留钡高度两组无统计学差异（P〉O．05），治疗后12和24个月两组的贲门口直径、5min存留钡高度有统计学差异（P〈O．05）。结论气囊扩张联合肉毒毒素局部注射治疗贲门失弛缓症，具有疗效高、持续时间长、患者痛苦小等优点，是治疗责门失弛缓症的有效方法之一。

Clinical Study on Intrasphincteric Injection of Botulinum Toxin and Balloon Dilation in Patients with Esophageal Achalasia

Objective To investigate the effectiveness of patients with esophageal achalasia treated with the combination of both halloon dilation and intrasphincteric iniection of hotulinum toxin- A. Methods Twenty-eight patients with esophageal achalasia were divided randomly into group A and B, the individuals in group A was treated with mare balloon dilation and the Group B was treated with the combination of both balloon dilation and intrasphincteric injection of botuli- num toxin. They were followed up for more than twenty-four months, and the clinical scores, lower oesophageal sphine- teric pressure, and lower oesophageal sphincteric relax rate oesophageal sphincter diameter were observed respectively at three months, twelve months and twenty-four months after treatment. Results There were no difference in effectiveness between group A and B at three months after treatment,but at twelve months after treatment the effective rates and gaps of LESP an d LESRR in combination group were higher than those in the mare balloon dilation group. At three months ＂after treatment, the diameter of Ben at the door, five min retained barium was no significant difference in height of the two groups （P〉0.05）, after treatment twelve and twenty-four months the two groups in front of the Ben-diameter, five rain hold Barium has a high degree of statistical difference （P〈0.01）. Complications never happened in two groups. Con- clusions Intrasphincteric injection of botulinum toxin and balloon dilation in patients with esophageal aehalasia was the effective procedure with the advantages of lasting longer time, less complications and milder chest pain,one of the effectiveness ways.