Predictors of outcome following cricopharyngeal disruption for pharyngeal dysphagia
Predictors of outcome following cricopharyngeal disruption for pharyngeal dysphagia
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DOI：
10.1007/pl00009527
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发表时间：
1997-06-01
期刊：
影响因子：
2.6
通讯作者：
Cook, IJ
中科院分区：
文献类型：
--
作者：
Ali, GN;Wallace, KL;Cook, IJ
咽部吞咽困难中环咽破坏后的适应症和结果预测因素尚不明确。我们的目的是检查口咽吞咽困难患者通过肌切开术或扩张术对环咽部破坏的症状反应，并确定治疗前测压或放射学结果的预测因素。使用同步咽部视频放射检查和测压法，我们研究了 20 名在环咽扩张术 (n = 11) 或肌切开术 (n = 8) 之前患有咽部吞咽困难的患者和 23 名健康对照者。我们测量了咽部峰值压力、下咽部推注压力、食管上括约肌直径和协调性。对括约肌破坏的反应率为 65%。与对照组相比，患者的括约肌张开程度显着减小（p = 0.004），但括约肌张开受损并不是结果的预测因子。下咽部推注压力增加（10 ml 推注> 19 mmHg；20 ml 推注> 31 mmHg）是结果的显着预测因素（p = 0.01）。峰值咽压和不协调都不是结果的预测因素。在咽部吞咽困难中，下咽部推注压力而非峰值咽部压力是环咽破坏反应的预测因子。推注内压力与括约肌开放受损之间的关系是括约肌顺应性的间接测量，有助于预测治疗反应。
The indications for, and predictors of outcome following cricopharyngeal disruption in pharyngeal dysphagia are not clearly defined. Our purpose was to examine the symptomatic response to cricopharyngeal disruption, by either myotomy or dilatation, in patients with oral-pharyngeal dysphagia and to determine pretreatment manometric or radiographic predictors of outcome. Using simultaneous pharyngeal videoradiography and manometry, we studied 20 patients with pharyngeal dysphagia prior to cricopharyngeal diltation (n = 11) or myotomy (n = 8), and 23 healthy controls. We measured peak pharyngeal pressure, hypopharyngeal intrabolus pressure, upper esophageal sphincter diameter, and coordination. Response rate to sphincter disruption was 65%. The extent of sphincter opening was significantly reduced in patients compared with controls (p = 0.004), but impaired sphincter opening was not a predictor of outcome. Increased hypopharyngeal intrabolus pressures (> 19 mmHg for 10 ml bolus; > 31 mmHg for 20 ml bolus) was a significant predictor of outcome (p = 0.01), Neither peak pharyngeal pressure nor incoordination were predictors of outcome. In pharyngeal dysphagia, hypopharyngeal intrabolus pressure, and not peak pharyngeal pressure, is a predictor of response to cricopharyngeal disruption. The relationship between intrabolus pressure and impaired sphincter opening is an indirect measure of sphincter compliance which helps predict therapeutic response.