Dilatation therapy for dysphagia in patients with upper esophageal sphincter dysfunction--manometric and symptomatic response.
Dilatation therapy for dysphagia in patients with upper esophageal sphincter dysfunction--manometric and symptomatic response.
复制标题
上食管括约肌功能障碍患者吞咽困难的扩张治疗——测压和症状反应。
DOI：
10.1093/dote/11.4.254
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发表时间：
1998
期刊：
影响因子：
--
通讯作者：
Castell,DO
中科院分区：
文献类型：
--
作者：
Hatlebakk,JG;Castell,JA;Spiegel,J;Paoletti,V;Katz,PO;Castell,DO
由于口咽吞咽困难而无法维持口服营养在患有各种神经和神经肌肉疾病的患者中很常见，并严重影响生活质量。环咽扩张已被用作这些患者的经验性治疗，但几乎没有关于症状反应的数据，也没有关于对上食管括约肌（UES）和咽部测压特征影响的数据。我们研究了10例口咽吞咽困难的患者，这些患者要么食管上括约肌静息压升高，要么残余压高，要么吞咽时松弛时间缩短。使用18-20 mm Savary扩张器进行扩张治疗，平均4周后重复测压。10名患者中有9名吞咽困难得到改善，并在平均13个月的随访中维持口服营养。10例患者中9例UES残余压下降，组内中位数由治疗前的10.8mmHg降至治疗后的5.7mmHg，差异有统计学意义（P <0.05）。10例患者中有8例UES静息压下降，组内中位数由82 mmHg降至43 mmHg（P <0.05）。放松的持续时间没有显着变化。9例治疗应答者中有5例影像学检查正常。对于选定的口咽吞咽困难和UES功能障碍的测压体征的患者，扩张治疗可以明显通过降低UES静息压和/或增加松弛的持续时间和完整性来显著缓解症状。
Inability to maintain oral nutrition due to oropharyngeal dysphagia is common in patients with a variety of neurological and neuromuscular disorders and severely affects quality of life. Cricopharyngeal dilatation has been used as empiric therapy in these patients, but little data exist on symptom response and there is no data on the effect on the manometric characteristics of the upper esophageal sphincter (UES) and pharynx. We studied 10 patients with oropharyngeal dysphagia and either elevated upper esophageal sphincter resting pressure, or a high residual pressure or attenuated duration of relaxation on swallowing. Dilatation therapy was performed with an 18-20 mm Savary dilator and manometry was repeated after an average period of 4 weeks. Nine out of 10 patients had improvement in dysphagia and have maintained oral nutrition for a mean follow-up of 13 months. UES residual pressure decreased in nine out of 10 patients and the group median value decreased significantly from 10.8 mmHg pretreatment to 5.7 mmHg after therapy(P <0.05). UES resting pressure decreased in eight out of 10 patients and the group median value decreased from 82 to 43 mmHg(P <0.05). Duration of relaxation did not change significantly. Videoradiography was normal in five out of nine responders to therapy. For selected patients with oropharyngeal dysphagia and manometric signs of UES dysfunction, dilatation therapy may give excellent symptomatic relief, apparently by reducing UES resting pressure and/or increasing the duration and completeness of relaxation.