摘要：

目的 探讨柱状球囊扩张术治疗脑卒中后食管上括约肌失弛缓致重度吞咽障碍患者的作用机制及效果。 方法 共64 例脑卒中后食管上括约肌失弛缓致重度吞咽障碍患者，随机接受脑卒中常规药物治疗和常规吞咽康复训练（对照组，32 例）以及在此基础上联合柱状球囊扩张术（治疗组，32 例），分别于治疗前和治疗终点或治疗4 周时行吞咽动作影像学、食管上括约肌动力学和吞咽障碍程度评分。 结果 与治疗前相比，治疗后两组患者静息压（P = 0.000）和残留压（P = 0.000）降低、峰值压力升高（P = 0.000）、松弛持续时间延长（P = 0.000），吞咽障碍程度评分升高（P = 0.000，0.000）；与对照组相比，治疗后治疗组患者静息压（P = 0.001）和残留压（P = 0.000）降低、峰值压力升高（P = 0.002）、松弛持续时间延长（P = 0.000），吞咽障碍程度评分升高（P = 0.000）。至治疗终点或治疗4 周时，治疗组总有效率高于对照组［93.75%（30/32）对81.25%（26/32）；χ² = 4.010，P = 0.000］。 结论 柱状球囊扩张术有助于降低食管上括约肌张力、缓解痉挛，对食管上括约肌失弛缓具有明显的针对性治疗作用。

关键词: 卒中, 食管失弛症, 食管括约肌, 上段, 吞咽障碍, 气囊扩张术, 康复

Abstract:

Objective To investigate the mechanism and effect of columnar balloon dilatation therapy on treating patients with severe dysphagia caused by upper esophageal sphincter (UES) achalasia after stroke. Methods Sixty -four patients with severe dysphagia caused by UES achalasia after stroke were diagnosed through Video Fluoroscopic Swallowing Study (VFSS) and esophageal dynamics testing. The patients were randomly divided into control group (N = 32) and treatment group (N = 32). Patients in control group were treated with routine drug treatment and routine rehabilitation training, while patients in treatment group were treated with columnar balloon dilatation therapy on the basis of routine treatment. The treatment end point was either the patient resuming an oral diet or after 4-weeks treatment. All cases were evaluated by swallowing function of VFSS, high resolution manometry (HRM) and scores of the severity of dysphagia before treatment and at treatment end point. Results Compared with before treatment, UES resting pressure (P = 0.000) and residual pressure (P = 0.000) were significantly decreased, peak pressure was significantly increased (P = 0.000), duration of relaxation was prolonged (P = 0.000), and scores of the severity of dysphagia were significantly increased (P = 0.000, 0.000) in both groups after treatment. Compared with control group, UES resting pressure (P = 0.001) and residual pressure (P = 0.000) were significantly decreased, peak pressure was significantly increased (P = 0.002), duration of relaxation was prolonged (P = 0.000), and scores of the severity of dysphagia were significantly increased (P = 0.000) in treatment group after treatment. Until the treatment end point or after 4-week treatment, the total effective rate in treatment group was significantly higher than that in control group [93.75% (30/32) vs. 81.25% (26/32); χ² = 4.010, P = 0.000]. Conclusions Columnar balloon dilatation therapy is effective for reducing the tension of upper esophageal sphincter and relieving spasm after stroke. It has obvious therapeutic effect on the upper esophageal sphincter achalasia.

Key words: Stroke, Esophageal achalasia, Esophageal sphincter, upper, Deglutition disorders, Balloon dilatation, Rehabilitation