超声引导下肉毒毒素环咽肌注射治疗延髓背外侧综合征所致吞咽障碍1例报道

doi:10.3969/j.issn.1006-9771.2020.11.020

《中国康复理论与实践》 ›› 2020, Vol. 26 ›› Issue (11): 1358-1364.doi: 10.3969/j.issn.1006-9771.2020.11.020

• 临床观察 • 上一篇

超声引导下肉毒毒素环咽肌注射治疗延髓背外侧综合征所致吞咽障碍1例报道

杨瑛^1,^2a,许梅娜^2b,李相良^2c,谢峦^2a,金海鹏^2c()

1.福建中医药大学,福建福州市 350122
2a.北京中医药大学厦门医院, 针灸学院,福建厦门市 361009
2b.北京中医药大学厦门医院, 超声医学科,福建厦门市 361009
2c.北京中医药大学厦门医院, 针灸康复科,福建厦门市 361009

收稿日期:2020-02-16 修回日期:2020-09-02 出版日期:2020-11-25 发布日期:2020-11-24
通讯作者: 金海鹏 E-mail:13066081@qq.com
作者简介:杨瑛(1996-),女,汉族,福建莆田市人,硕士研究生,主要研究方向：针灸治疗脑病的临床研究。|金海鹏(1977-),男,汉族,上海市人,硕士,副主任医师,硕士研究生导师,主要研究方向：针刺结合康复治疗神经系统疾病。

Cricopharyngeal Botulinum Toxin Injection under Ultrasonic Guidance for Dysphagia from Wallenberg’s Syndrome: A Case Report

YANG Ying^1,^2a,XU Mei-na^2b,LI Xiang-liang^2c,XIE Luan^2a,JIN Hai-peng^2c()

1. Fujian University of Traditional Chinese Medicine, Fuzhou, Fujian 350122, China
2a. College of Acupuncture, Xiamen Hospital of Beijing University of Traditional Chinese Medicine, Xiamen, Fujian 361009, China
2b. Department of Ultrasound Medicine, Xiamen Hospital of Beijing University of Traditional Chinese Medicine, Xiamen, Fujian 361009, China
2c. Acupuncture Rehabilitation Department, Xiamen Hospital of Beijing University of Traditional Chinese Medicine, Xiamen, Fujian 361009, China

Received:2020-02-16 Revised:2020-09-02 Published:2020-11-25 Online:2020-11-24
Contact: JIN Hai-peng E-mail:13066081@qq.com

摘要/Abstract

摘要：

目的采用超声引导下肉毒毒素环咽肌注射治疗延髓背外侧综合征所致吞咽障碍。方法回顾本院1例临床资料。结果患者延髓背外侧梗死后,导致环咽肌失弛缓,经常规吞咽治疗和球囊扩张术后未见明显好转,予超声引导下肉毒毒素环咽肌注射,经藤岛一郎摄食-吞咽功能等级量表、Rosenbek渗漏-误吸量表评定和透视荧光吞咽检查分析,吞咽功能改善,治疗后1个月和3个月随访,吞咽功能正常。结论超声引导下肉毒毒素注射治疗延髓背外侧综合征所致环咽肌失弛缓有一定的近期和远期效果。

关键词: 延髓背外侧综合征, 吞咽障碍, 环咽肌失弛缓, 肉毒毒素, 超声引导

Abstract:

Objective To investigate the effect of cricopharyngeal injection of Botulinum toxin under ultrasonic guidance for treatment of dysphagia caused by Wallenberg’s syndrome.Methods A case was reviewed.Results This patient was diagnosed as cricopharyngeal achalasia after dorsal lateral rostral infarction, and responded poor to routine treatment for swallowing disorders, including balloon dilatation. He accepted cricopharyngeal Botulinum toxin injection under ultrasonic guidance. As evaluated with Toshima Ichiro Ingestion-Swallowing Function Rating Scale, Rosenbek Penetration-Aspiration Scale and videofluoroscopic swallowing study (VFSS), his swallowing improved after treatment, and became normal as follow-up one and three months after treatment.Conclusion Cricopharyngeal Botulinum toxin injection under ultrasonic guidance is feasible for cricopharyngeal achalasia of Wallenberg’s syndrome with immediate and long-term effect.

Key words: Wallenberg’s syndrome, dysphagia, cricopharyngeal achalasia, Botulinum toxin, ultrasonic guidance

中图分类号:

R743.3

杨瑛,许梅娜,李相良,谢峦,金海鹏. 超声引导下肉毒毒素环咽肌注射治疗延髓背外侧综合征所致吞咽障碍1例报道[J]. 《中国康复理论与实践》, 2020, 26(11): 1358-1364.

YANG Ying,XU Mei-na,LI Xiang-liang,XIE Luan,JIN Hai-peng. Cricopharyngeal Botulinum Toxin Injection under Ultrasonic Guidance for Dysphagia from Wallenberg’s Syndrome: A Case Report[J]. 《Chinese Journal of Rehabilitation Theory and Practice》, 2020, 26(11): 1358-1364.

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时间	藤岛一郎摄食-吞咽功能	渗漏-误吸量表
常规治疗前	2	8
常规治疗1周后	3	8
A型肉毒毒素治疗后第2天	9	1
出院后1个月	10	1
出院后3个月	10	1

时间	藤岛一郎摄食-吞咽功能	渗漏-误吸量表
常规治疗前	2	8
常规治疗1周后	3	8
A型肉毒毒素治疗后第2天	9	1
出院后1个月	10	1
出院后3个月	10	1

时间	舌骨上移 (mm)	舌骨前移 (mm)	甲状软骨上移 (mm)	甲状软骨前移 (mm)	UES开放时间 (s)	UES开放幅度 (cm)	咽腔收缩率 (%)
常规治疗前	11	2	14	3	0.3	0.6	71.5
常规治疗1周后	12	3	17	3	0.4	0.7	73.4
A型肉毒毒素治疗后第2天	13	10	19	4	0.8	0.8	92.6
出院后1个月	18	12	21	5	0.9	1.0	94.9
出院后3个月	20	13	21	6	1.1	1.1	98.0

时间	舌骨上移 (mm)	舌骨前移 (mm)	甲状软骨上移 (mm)	甲状软骨前移 (mm)	UES开放时间 (s)	UES开放幅度 (cm)	咽腔收缩率 (%)
常规治疗前	11	2	14	3	0.3	0.6	71.5
常规治疗1周后	12	3	17	3	0.4	0.7	73.4
A型肉毒毒素治疗后第2天	13	10	19	4	0.8	0.8	92.6
出院后1个月	18	12	21	5	0.9	1.0	94.9
出院后3个月	20	13	21	6	1.1	1.1	98.0

超声引导下肉毒毒素环咽肌注射治疗延髓背外侧综合征所致吞咽障碍1例报道

Cricopharyngeal Botulinum Toxin Injection under Ultrasonic Guidance for Dysphagia from Wallenberg’s Syndrome: A Case Report

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