摘要
目的:肉毒毒素是肉毒梭菌产生的一种细菌外毒素,可抑制神经肌肉接头处α运动神经元的传递,引起横纹肌肌力减弱,抑制副交感和胆碱能节后交感神经元乙酰胆碱释放,故可对消化道平滑肌痉挛起抑制作用。资料来源:应用计算机检索Medline1988-01/2003-12的关于肉毒毒素的文章,检索词包括Botulinumtoxin;achalasia;chronicanalfissure;Anismus;constipation等,并限定文章语言种类为English。资料选择:对资料进行初审,选择与肉毒毒素的分子结构、作用机制、胃肠领域中的应用适应症、毒副作用相关的研究原著。排除标准:重复性研究。资料综合:肉毒毒素在胃肠领域中主要适应症有贲门失弛缓症、迷走神经切断术后难治性幽门痉挛、先天性胃麻痹、Oddis括约肌功能失调、出口梗阻型便秘、慢性肛裂、肛门痉挛等。尤其在贲门失弛缓症的治疗中,肉毒毒素注射与气囊扩张和食管下括约肌切开相比较,显示了各自的优缺点。资料提炼:共收集到97篇关于肉毒毒素的研究原著,涉及肉毒毒素分子结构的9篇,作用机制的17篇,胃肠领域中应用适应症的65篇,与毒副作用相关的6篇,符合纳入标准30篇,排除67篇。实际分析15篇。结论:括约肌内注射肉毒毒素治疗贲门失弛缓症的短期效果已经得到肯定,对其他胃肠动力性疾病,如弥漫性食管痉挛,Oddis括约肌?
OBJECTIVE:Botulinum toxin produced by clostridium botulinum is an exotoxin.It can inhibit the transmission of alpha motor neuron at neuromuscular junction and reduce muscle strength of striated muscle.Its inhibition to the release of acetylcholine at parasympathetic and cholinergic postganglionic sympathetic neurons,so that it can play a role in inhibiting the smooth muscular spasticity of alimentary tract. DATA SOURCES:An online search of Medline was performed to identify articles about botulinum toxin published in English from January 1988 to December 2003 by using the keywords of “botulinum toxin;achalasia;chronic anal fissure;anismus;constipation'. STUDY SELECTION:After the above selection,the original literatures related to the molecular structure,mechanism of botulinum toxin,indications in digestive tract and the side effects of botulinum toxin were collected.Exclusion criteria:repetitive study. DATA EXTRACTION:Ninety-seven original literatures about botulinum toxin were collected,9 referred to the molecular structure of botulinum toxin,17 about its mechanism,65 about its indications in digestive tract,and 6 related to its side effects.Among them,30 met the inclusion criteria,and 67 were excluded. DATA SYSTHESIS:The main indications of botulinum toxin in digestive tract were achalasia of cardia,refractory pylorospasm after vagotomy,congenital gastroplegia,functional disorder of Oddis sphincter,outlet obstructive constipation,chronic anal fissure and anal spasm.Especially in treating achalasia of cardia,injection of botulinum toxin showed its advantages and disadvantages as compared with dilataltion of air pocket and incision of inferior esophageal sphincter. CONCLUSION:The short-term effect of the injection of botulinum toxin into sphincter in treating achalasia of cardia has been confirmed.Botulinum toxin is still a new therapeutic method for other gastrointestinal diseases,such as diffuse spasm of esophagus,functional disorder of Oddis sphincter and anal spasm.No severe side effect is observed at present.
出处
《中国临床康复》
CSCD
北大核心
2005年第15期147-149,共3页
Chinese Journal of Clinical Rehabilitation
