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目的介绍内镜下注射 A型肉毒毒素（ BTXA）治疗贲门失弛缓症 (AC)的方法，探讨其近期疗效。方法原发性 AC患者 13例，于治疗前和治疗后 1周做症状计分和食管造影（测量贲门开口、 5分钟食管存留造影剂的高度和平均宽度）。内镜下于贲门齿状线上 0.5cm分 4点各注射 BTXA 20U至下食管括约肌。结果治疗次日症状即明显缓解，咽下困难频度、咽下困难程度、反食频度、胸骨后疼痛频度计分均明显减少；贲门开口由治疗前的 (1.5± 1.8)mm增大至 (4.4± 2.4)mm， P< 0.001； 5分钟食管碘柱高度和平均宽度分别由治疗前的 (89.5± 37.4)mm和 (31.9± 11.3)mm降至治疗后的 (14.4± 22.0)mm和 (8.4± 9.4)mm， P< 0.001。结论内镜下注射 BTXA治疗 AC安全、经济、简便易行，近期效果良好。
Objective To introduce the method of endoscopic injection of botulinum toxin type A (BTXA) for the treatment of achalasia (AC) and to investigate its short-term curative effect. Methods Thirteen patients with primary AC had symptom scores and esophageal angiography (measured cardiac opening, 5-minute esophageal contrast medium height and mean width) before and 1 week after treatment. Endoscopic cardiomyotomy line 0.5cm points 4:00 each injected BTXA 20U to the lower esophageal sphincter. Results The symptoms of the second day of treatment were relieved. The frequency of dysphagia, degree of dysphagia, frequency of anti-retroviral therapy and post-sternal pain frequency were significantly decreased. The opening of cardia was increased from (1.5 ± 1.8) mm before treatment To (4.4 ± 2.4) mm, P <0.001; 5-minute esophageal iodine column height and mean width decreased from (89.5 ± 37.4) mm and (31.9 ± 11.3) mm before treatment to (14.4 ± 22.0) mm after treatment And (8.4 ± 9.4) mm, P <0.001. Conclusions Endoscopic injection of BTXA is safe, economical and easy to operate with good results in the near future.