环枕畸形神经源性吞咽困难的临床研究

本文报道我院１９７５～１９９２年间收治的８４例环枕畸形病例，其中２８例表现有神经源性吞咽困难。这些病人在出现吞咽困难症状前均有正常吞咽功能。病人的吞咽困难呈进行性发展，严重者合并咽喉区功能障碍、鼻咽部反流和气管内吸入。除１例外，均行颅后窝减压以及环椎后弓和Ｃ２，３椎板切除术。术后２例因中枢性呼吸衰竭和吸入性肺炎死亡。２１例行追踪观察（随防期６个月～１１年，平均３．２年），１６例（７６．２％）症状消失或改善。作者讨论了本病的病机与诊治方法，并指出早期认识本征象并采取手术治疗，对促进神经功能恢复具有重要意义。

Clinical Study of Neurogenic Dysphagia Resulting from Atlantooccipital Malformations

From 1975 to 1992, 28 of 86 patients who were admitted to our hospital for symptomatic atlanooccipital malformations presented with manifestations of neurogenic dysphagia. Each of these patients had normalswallowing function befoe the occurrence ofdysphagic symptoms. Dysphagia was progressive, and serious patients had also tracheopharyngeal dysfunction, nasal refluxwith tracheal inspiration. All patients exceptone case underwent posterior fossa decompression and the laminectomy of perivertebral posterior arch. After operation, two patientsdied of central apnea or aspiration pneumonitis. Twenty--one patients were reviewed postoperatively. The period of follow-up variedfrom 6 months to 11 years, with a mean of3. 2 years. The disappearance or improvenment of preoperative symptoms occurred in16 patients(76. 2 % ). The pathophysiology,model of diagnosis and treatment of this disease were discussed in the article. The authors conclude that early recognition of neurogenic dysphagia and surgical interventionwere important in promoting a favorable neurological recovery.