气囊扩张与肉毒毒素注射序贯联合治疗贲门失弛缓症的临床研究

目的 研究气囊扩张序贯联合A型肉毒毒素注射治疗贲门失弛缓症的近、远期疗效。方法 43例被确诊原发性贲门失弛缓症的患者随机分成两组：A组接受单纯气囊扩张治疗；B组接受气囊扩张治疗1周后，在内镜直视下LES内注射A型肉毒毒素治疗。分别于治疗后1、3、6、12和24个月随访观察患者的临床症状评分、贲门口内径、5min存留钡柱高度等。结果 治疗后3个月两组的近期疗效显著，但无统计学差异。治疗后6、12和24个月B组的有效率分别为72．2％、61．1％、40％，高于气囊扩张治疗组36％、28％、16％，有统计学差异，其中治疗后12、24个月序贯联合组的有效率显著高于气囊扩张治疗组。A组有9例分别于治疗后8、12、17个月因再次出现进食困难进行再次扩张。结论 气囊扩张序贯联合食管下括约肌内注射A型肉毒毒素治疗技术操作简单，安全性高，治疗费用经济，且近远期疗效高，是兼顾病因治疗、对症治疗行之有效的方法之一。

Clinical study on intrasphincteric injection of botulinum toxin-A and balloon dilation in patients with esophageal achalasia

Objective] To investigate the effectiveness and the near, post date curative adverse effects between two groups of patients with esophageal achalasia treated with mare balloon dilation and combination of both balloon dilation and intrasphincteric injection of botulinum toxin-A. Methods] Forty-three patients were diagnosed Achalasia by oesophagus barium X-ray and endoscopecope, They were divided randomly into two groups. Group A: treated with mare balloon dilation, Group B: combination of both balloon dilation and intrasphincteric injection of botulinum toxin. They were followed up for more than 24 months, the clinical scores, oesophageal sphincter diameter, etc. were observed respectively at 1 week, 1 months, 3 months, 6 months, 12 months and 24 months after treatment. Results] Near curative effect: There were markedly high therapeutic rate in both two groups, but no effective rate difference in statistics between two groups during 3 mouths after treatment. Post date effect of Group B: in 13 cases (72.2%), 11 cases (61.1%), 10 cases (40%) effective, respectively higher than that of Group A: 9 cases (36%), 7 cases (28%), 4 cases (16%) at 6 months, 12 months and 24 months after treatment. 8~17 mouths posts 9 of 25 cases instance in Group A relapse after mere balloon dilation. Conclusion] Intrasphincteric injection of botulinum toxin and balloon dilation in patients with esophageal achalasia is one of the simple?safe?economic and effectiveness ways both in the near, post date curative adverse effects, giving consideration to both pathogeny and symptoms.