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目的:比较气囊扩张及肉毒杆菌毒素治疗贲门失弛缓症的近、远期疗效。方法:对31例患者(扩张组18例,注射组13例)进行1个月和1年随访观察,通过对临床症状、X线钡餐检查、胃镜检查和食管测压等进行比较分析。结果:18例行肉毒杆菌毒素注射患者治疗前,下食管括约肌静息压(LESP)为(8.34±1.62)kPa,松弛率(LESR)为(30.45±3.36)％。治疗后1周LESP,降至(4.13±0.42)kPa,LESR为(50.87±3.47)％。13例行气囊扩张术患者治疗前LESP为(7.58±1.48)kPa,LESR为(29.45±2.29)％。治疗后1周LESP降至(4.53±0.38)kPa,LESR为(48.47±3.32)％。两者运动学参数改善无明显差异,但行气囊扩张术有贲门黏膜撕裂、擦伤、渗血等并发症。结论:肉毒杆菌毒素注射和气囊扩张均为治疗贲门失弛缓症安全有效的方法,但气囊扩张术并发症更多。
Objective: To compare the short-term and long-term effects of balloon dilatation and botulinum toxin in the treatment of achalasia. Methods: Thirty-one patients (18 in the expansion group and 13 in the injection group) were followed up for 1 month and 1 year respectively. The clinical symptoms, X-ray barium meal examination, gastroscopy and esophageal manometry were compared and analyzed. Results: The resting esophageal sphincter pressure (LESP) was (8.34 ± 1.62) kPa and the relaxation rate (LESR) was (30.45 ± 3.36)% in 18 patients before botulinum toxin injection. LESP decreased to (4.13 ± 0.42) kPa and LESR was (50.87 ± 3.47)% at 1 week after treatment. LESP was (7.58 ± 1.48) kPa and LESR was (29.45 ± 2.29)% before treatment in 13 patients with balloon dilatation. LESP decreased to (4.53 ± 0.38) kPa and LESR was (48.47 ± 3.32)% at 1 week after treatment. Kinematics parameters between the two no significant difference, but the line balloon dilatation of gastric cardia tear, abrasion, bleeding and other complications. Conclusion: Botulinum toxin injection and balloon dilatation are both safe and effective in the treatment of achalasia, but the complications of balloon dilatation are more.