摘要
目的:通过针对性病史采集和体格检查分析一组合并吞咽障碍ChiariⅠ畸形患者吞咽障碍的发生情况、手术前后主要临床特点变化,总结探讨ChiariⅠ畸形患者寰枕减压硬膜成形术后吞咽功能变化及其意义。方法:对2007年1月至2010年6月北京大学第三医院神经外科收治的126例经临床及磁共振证实的ChiariⅠ畸形患者的临床资料进行前瞻性分析,筛选出合并不同程度吞咽困难症状者34例(26.9%,34/126)。所有患者均行寰枕减压硬膜成形术,于术前1 d及术后7～10 d行洼田饮水试验评定其吞咽困难程度,对其手术前后改变进行统计学分析,对比手术前后其他主要症状体征改善情况。结果:术后患者吞咽困难症状消失和改善共23例,有效率67.6%(23/34)。术前洼田饮水试验评分为2.74±1.11,在手术治疗后得分降低至1.71±0.91,两者比较P<0.05,表明经手术干预后患者的吞咽能力于术后近期得到明显改善,其他主要症状的术后改善情况经Fisher’s精确检验分析,术后仅颈肩痛(P=0.01)和吞咽障碍(P=0.01)改善明显,与术前相比差异有统计学意义(P<0.05)。结论:部分ChiariⅠ畸形患者合并不同程度的吞咽障碍,临床上通过针对性病史询问及体格检查有助于提高吞咽障碍的初始检出率,洼田饮水试验能够对吞咽功能进行初步筛查且做到部分定量。寰枕减压硬膜成形术能提高合并吞咽障碍ChiariⅠ畸形患者的吞咽能力,观察术后吞咽困难改善是评价近期手术效果的有效指标。
Objective：To survey changes of swallowing function and their significance in Chiari Ⅰ malformation patients with dysphagia after Atlanto-occipital Decompression with Duraplasty by comparing water swallowing test results and other clinical features before and after surgery.Methods： From January 2007 to July 2010,126 Chiari Ⅰmalformation patients were treated in Neurosurgery Department of Peking University Third Hospital.Clinical data were prospectively analyzed.There were 34 cases（26.9%,34/126） with varying severity of dysphagia.All of those patients underwent Atlanto-occipital Decompression with Duraplasty.Water swallowing tests were performed 1 day before operation and after 7-10 days to assess dysphagia severity.The improvements of other major symptoms and signs after surgery were also compared.Results： Postoperative dysphagia was improved in 23 cases（67.6%,23/34）,and drinking water test score of preoperation was（2.74±1.11）.The score was significantly reduced to（1.71±0.91） after the operation（P0.05）.Other major symptoms and signs were analyzed by Fisher＇s exact test which showed that only neck and shoulder pain（P=0.01） improved significantly,compared with preoperation.Conclusion： Indeed part of the Chiari Ⅰmalformation patients suffer from varying severity of dysphagia.The detailed clinical history collection and physical examination may improve the initial detection rate of dysphagia.Water swallow test is useful to quantify the degree of dysphagia.Atlanto-occipital Decompression with Duraplasty can improve treatment of Chiari Ⅰmalformation patients with dysphagia.Improvement in treating dysphagia shortly after operation may be an effective index to evaluate the effect of surgery.
出处
《北京大学学报（医学版）》
CAS
CSCD
北大核心
2011年第6期873-877,共5页
Journal of Peking University:Health Sciences
