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目的 :探讨和评价内镜下食管括约肌 ( LES)内注射肉毒毒素 A治疗贲门失弛缓症的临床疗效。方法 :1 2例患者经食管钡餐透视、胃镜检查证实为原发性贲门失弛缓症。注射前禁食 1 0 h,将肉毒毒素 A1 0 0单位用生理盐水稀释后 ,用 Olympus注射针在齿状线上方 0 .5 cm处选择 5个点进行食管括约肌内注射 ,每点注射肉毒毒素 2 0单位 ,术后禁食4h。疗效标准 :痊愈 (症状消失 ,造影时见 LES呈松弛状态 ) ;显效 (症状明显改善 ,偶有发作 ,L ES区间断开放 ) ;有效 (症状不同程度改善 ,LES区见部分钡剂由食管流入胃内 ) ;无效 (症状无改善 )。结果 :经内镜注射治疗后痊愈 1 0例 ,占 83.3% ;显效 1例 ,占 8.33% ;有效 1例 ,占 8.33% ,无无效病例。结论 :内镜下注射肉毒毒素 A治疗贲门失弛缓症简单、安全、有效 ,无明显的副作用和并发症 ,特别适用于不能耐受创伤治疗如球囊扩张的病人
Objective: To investigate and evaluate the clinical efficacy of botulinum toxin A in the treatment of achalasia in endoscopic esophageal sphincter (LES). Methods: One hundred and two patients underwent trans-esophageal barium meal fluoroscopy. Gastroscopy confirmed primary achalasia. Fasting 10 h before injection, botulinum toxin A1 0 0 units diluted with saline, with Olympus injection needle at the top of the dentate line at 0.5 cm at 5 points selected for intra-esophageal sphincter injection, each injection of meat Toxins 20 units, fasting 4h. Efficacy criteria: recovery (symptom disappeared, angiography see LES was relaxed); markedly (significant improvement in symptoms, occasional episodes, L ES interval open release); effective (symptoms of varying degrees of improvement, LES area to see part of the barium esophageal inflow Stomach); invalid (no improvement in symptoms). Results: 10 cases were cured by endoscopic injection, accounting for 83.3%. One case was markedly effective, accounting for 8.33%. One case was effective, accounting for 8.33%. There was no case of ineffective treatment. CONCLUSIONS: Endoscopic injection of botulinum toxin A in the treatment of achalasia is simple, safe and effective with no obvious side effects and complications. It is especially suitable for patients who can not tolerate trauma such as balloon dilatation