Retrospective Study On The Achalasia Range Of The Upper Esophageal Sphincter In Patients With Bulbar Paralysis

ObjectiveTo observe the achalasia range of the upper esophageal sphincter in patients with bulbar paralysis through X-ray or CT contrast-enhanced balloon localization,so as to support clinical localization for botulinum toxin injection.MethodsA total of 48 patients with bulbar paralysis(with all relevant lesions at the medulla oblongata)treated between September 2016 and May 2019 were selected for a retrospective analysis,in which the X-ray contrast medium balloon location was performed for 27 cases(including 21 with cerebral infarction,2 optic nerve myelitis,2 ependymoma,and 2 craniocerebral trauma),and the CT contrast medium balloon location was performed for 21 cases(including 15 with cerebral infarction,2 optic nerve myelitis,1 brain glioma,2 ependymoma,and 1 craniocerebral trauma),so as to observe the correspondence between the upper margin of the balloon and the vertebrae,and measure the distance from the upper edge of the contrast balloon to the lower edge of the C6 vertebra.For the data comparison between X-ray group and CT group,the paired samples t test was used,and the results showed that there was no significant difference(p=0.65>0.05).A subsequent statistical analysis combined the X-ray and CT data for processing,to study the correlation of distance from the lower edge of C6 vertebra to the upper edge of balloon with age,course of disease,height,weight and Bathel index respectively through the Pearson correlation test.The independent-samples T test was used to study the difference in the distance from the lower edge of C6 vertebra to the upper edge of balloon for gender.For the verified factors related to the distance from the lower edge of C6 vertebra to the upper edge of balloon,a linear regression analysis was carried out.ResultsThe measured distance from the lower edge of C6 vertebra to the upper edge of balloon was 19.05± 12.14mm in the X-ray group and 18.97± 12.07mm in the CT group.There was no significant difference between the two groups(p>0.05).For the 48 patients,the distance from the lower edge of C6 vertebra to the upper edge of balloon averaged 19.01±11.98mm,and the upper edge of the balloon was mostly located at the C7-T1 vertebrae.In the X-ray group,the upper edge of the balloon was flush with C6 vertebra in 5 cases,C7 vertebra in 6 cases,T1 vertebra in 14 cases,and T2 vertebra in 2 cases.In the CT group,the upper edge of the balloon was flush with C6 vertebra in 2 cases,C7 vertebra in 9 cases,T1 vertebra in 9 cases,and T3 vertebra in 1 case.A correlation analysis showed that for the 48 patients,age was correlated with the distance from the lower edge of C6 vertebra to the upper edge of balloon(r=0.389,p=0.006<0.01),while the course of disease,height,weight,and Bathel index were not correlated with the distance from the lower edge of C6 vertebra to the upper edge of balloon for both groups(p>0.05).Age accounted for 15.2%of the variation in the distance from the lower edge of C6 vertebra to the upper edge of balloon(R2=0.152).It may affect the distance(F=8.224,p=0.006<0.05).Relevant formula was as follows:C6-balloon distance=1.074+0.333*age,regression coefficient of age:0.333(t=2.868,p=0.006<0.01).ConclusionThe range of esophageal stenosis in patients with bulbar paralysis corresponds with the anatomical location of upper esophageal sphincter group,but previous botulinum toxin injections often targeted only the cricopharyngeus muscle.The results have shown that the upper esophageal sphincter group can be taken as the target for botulinum toxin injection.The range of achalasia for upper esophageal sphincter group was related to age,but irrelevant to course of disease,height,weight,and Bathel index.In the future,the location of upper esophageal sphincter for botulinum toxin injection will be further explored with enlarged sample size.