CAJ | 학술논문

目的探讨不同方式球囊扩张治疗环咽肌失弛缓所致吞咽障碍的疗效及作用机制.方法共选取30例脑干梗死后吞咽障碍患者,经吞咽X线荧光透视检查(VFSS)均证实为环咽肌失弛缓.采用随机数字表法将其分为球囊A组、球囊B组及球囊C组(每组10例),分别采用14号普通导尿管、14号改良双腔硅胶导管和22号普通导尿管经鼻或经口插入扩张治疗.于治疗50 d后对各组患者吞咽功能进行评定.结果治疗后3组患者吞咽障碍分级、VFSS检查结果均较治疗前明显改善(P＜0.05)；其中球囊A组、球囊C组吞咽障碍分级、VFSS检查结果均显著优于球囊B组(P＜0.05)；球囊A组及球囊C组间疗效差异无统计学意义(P＞0.05).在注入相同水量情况下,球囊A组、球囊C组球囊周长、囊内压力及球囊直径均显著大于球囊B组,组间差异均具有统计学意义(P＜0.05)；球囊A组与球囊C组间差异无统计学意义(P＞0.05).结论采用导尿管球囊扩张术治疗脑干梗死所致环咽肌失弛缓具有显著疗效,能有效缓解环咽肌失弛缓病情,改善患者吞咽功能；另外发现扩张疗效与球囊直径、囊内压力等具有明显相关性.
목적 탐토불동방식구낭확장치료배인기실이완소치탄인장애적료효급작용궤제.방법 공선취30례뇌간경사후탄인장애환자,경탄인X선형광투시검사(VFSS)균증실위배인기실이완.채용수궤수자표법장기분위구낭A조、구낭B조급구낭C조(매조10례),분별채용14호보통도뇨관、14호개량쌍강규효도관화22호보통도뇨관경비혹경구삽입확장치료.우치료50 d후대각조환자탄인공능진행평정.결과 치료후3조환자탄인장애분급、VFSS검사결과균교치료전명현개선(P＜0.05)；기중구낭A조、구낭C조탄인장애분급、VFSS검사결과균현저우우구낭B조(P＜0.05)；구낭A조급구낭C조간료효차이무통계학의의(P＞0.05).재주입상동수량정황하,구낭A조、구낭C조구낭주장、낭내압력급구낭직경균현저대우구낭B조,조간차이균구유통계학의의(P＜0.05)；구낭A조여구낭C조간차이무통계학의의(P＞0.05).결론 채용도뇨관구낭확장술치료뇌간경사소치배인기실이완구유현저료효,능유효완해배인기실이완병정,개선환자탄인공능；령외발현확장료효여구낭직경、낭내압력등구유명현상관성.
Objective To observe the effect of different ways of balloon catheter dilation techniques on cricopharyngeal achalasia and its mechanisms.Methods Thirty patients with deglutition disorder after brain stem infarction,whose cricopharyngeal achalasias were proven by videofluoroscopic swallowing study(VFSS),were randomly divided into three groups: No.14 conventional catheter group A,No.14 modified bicavitary silica-gel catheter group B and No.22 conventional catheter group C with 10 cases in each group,respectively.All the patients of 3 groups received multiple times corresponding balloon catheter dilatation per nasal or per os(No.22 conventional catheter group C only per os).Results After an average of 30 d of balloon catheter dilatation,the level of dysphagia and VFSS evaluation of all patients improved significantly(P ＜ 0.05).However,the No.14 conventional catheter group A and No.22 conventional catheter group C improved to a greater extent than No.14 modified bicavitary silica-gel catheter group B(P ＜ 0.05).The saccule perimeter,saccule diameter and saccule intracapsular pressure of No.14 conventional catheter group A and No.22 conventional catheter group C increased significantly(P ＜ 0.05)when compared to those of No.14 modified bicavitary silica-gel catheter group B,but there was no significant diffference beween No.14 conventional catheter group A and No.22 conventional catheter group C(P ＞ 0.05).Conclusions The balloon catheter dilation technique can significantly improve swallowing function of deglutition disorders patients with cricopharyngeal achalasia after brain stem infarction,which is related positively to saccule diameter and saccule intracapsular pressure.