咽喉反流在任克间隙水肿发病中的作用

王嘉森; 李进让

doi:10.13201/j.issn.1001-1781.2016.24.007

咽喉反流在任克间隙水肿发病中的作用

王嘉森,
李进让^,

- 海军总医院耳鼻咽喉头颈外科(北京, 100048)
基金项目:
海军总医院创新培育基金(No:CXPY201624)

详细信息

通讯作者: 李进让,E-mail:entljr@sina.com

中图分类号: R767.4

收稿日期: 2016-09-15

The role of laryngopharyngeal reflux in the pathogenesis of Reinke′s edema

WANG Jiasen,
LI Jinrang^,

- Department of Otorhinolaryngology Head and Neck Surgery, Navy General Hospital, Beijing, 100048, China

More Information

Corresponding author: LI Jinrang, E-mail: entljr@sina.com

Received Date: 15 September 2016

摘要

摘要: 目的:探讨咽喉反流在任克间隙水肿发病中的作用。方法:选取2014-02-2016-06诊断为任克间隙水肿的16例患者进行分析,以同期声带白斑和早期声门型喉癌50例患者作为对照组,对比分析两组间反流症状指数(RSI)、反流体征评分(RFS)、24 h咽喉酸反流次数、24 h咽喉酸反流时间和咽喉反流阳性率的差异。结果:任克间隙水肿患者的RSI评分均值为11.2±3.8,RFS评分均值为8.2±1.5,中位反流次数4.0[0.0;9.0]次,中位反流时间5.6[0.0;16.7]min,量表评分咽喉反流阳性率100%(16/16),24 h MII-pH监测结果示咽喉反流阳性率56.2%(9/16);对照组RSI评分均值为8.6±3.2,RFS评分均值为6.8±2.1,中位反流次数0.0[0.0;3.0]次,中位反流时间0.0[0.0;4.3]min,量表评分咽喉反流阳性率58.0%(29/50),24 h MII-pH监测结果示咽喉反流阳性率28.0%(14/50)。任克间隙水肿组RSI评分、RFS评分、24 h咽喉酸反流次数、24 h咽喉酸反流时间和咽喉反流阳性率均显著高于对照组,差异有统计学意义(P＜0.01或P＜0.05)。结论:咽喉反流与任克间隙水肿具有相关性,咽喉反流在任克间隙水肿发病中起一定作用,对任克间隙水肿患者治疗时应加抑酸治疗。
- 咽喉反流 /
- 任克间隙水肿 /
- 反流症状指数 /
- 反流体征评分
Abstract: Objective: To determine the significance of laryngopharyngeal reflux(LPR) in Reinke's edema.Method: Sixteen patients who have been diagnosed as Reinke's edema between February 2014 to June 2016 were included in this study. The control group included fifty vocal cord leukoplakia and early glottic cancer patients for the corresponding period. RSI,RFS,numbers of laryngopharyngeal acid reflux events,and time of laryngopharyngeal acid exposure were evaluated between two groups.Result: The mean RSI of the Reinke's edema was 11.2±3.8,the mean RFS was 8.2±1.5,the median numbers of laryngopharyngeal acid reflux events was 4.0[0.0;9.0],the time of laryngopharyngeal acid exposure was 5.6[0.0;16.7]min.The rate of LPR positive in Reinke's edema patients was 100.0%(16/16)by RSI and RFS,56.2%(9/16)by 24 hour MII-pH monitoring.The mean RSI of the control group was 8.6±3.2,the mean RFS was 6.8±2.1,the median numbers of laryngopharyngeal acid reflux events was 0.0[0.0;3.0],the time of laryngopharyngeal acid exposure was 0.0[0.0;4.3]min.The rate of LPR positive in control group was 58.0%(29/50)by RSI and RFS,28.0%(14/50)by 24 hour MII-pH monitoring.There were statistically significance in RSI,RFS,numbers of laryngopharyngeal acid reflux events,and time of laryngopharyngeal acid exposure between two groups(P＜0.01 or P＜0.05).Conclusion: Laryngopharyngeal reflux might play a role as an etiologic factor in Reinke's edema,awareness should increase about acid suppression therapy in Reinke's edema.
- laryngopharyngeal reflux /
- Reinke's edema /
- reflux symptom index /
- reflux finding score

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参考文献(19)

[1]	TAUBER S,GROSS M,ISSING W J.Association of laryngopharyngeal symptoms with gastroesophageal reflux disease[J].Laryngoscope,2002,112:879-886.
[2]	KOUFMAN J A.The otolaryngologic manifestations of gastroesophageal reflux disease(GERD):a clinical investigation of 225patients using ambulatory 24-hour pH monitoring and an experimental investigation of the role of acid and pepsin in the development of laryngeal injury[J].Laryngoscope,1991,101:1-78.
[3]	ZEITELS S M,HILLMAN R E,BUNTING G W,et al.Reinke's edema:phonatory mechanisms and management strategies[J].Ann Otol Rhinol Laryngol,1997,106(7Pt 1):533-543.
[4]	POWELL J,COCKS H C.Mucosal changes in laryngopharyngeal reflux--prevalence,sensitivity,specificity and assessment[J].Laryngoscope,2013,123:985-991.
[5]	BELAFSKY P C,POSTMA G N,KOUFMAN J A.Validity and reliability of the reflux symptom index(RSI)[J].J Voice,2002,16:274-277.
[6]	BELAFSKY P C,POSTMA G N,KOUFMAN J A.The validity and reliability of the reflux finding score(RFS)[J].Laryngoscope,2001,111:1313-1317.
[7]	李进让,肖水芳.咽喉反流性疾病诊疗研究中存在的问题[J].中华耳鼻咽喉头颈外科杂志,2014,49(5):353-355.
[8]	SMIT C F,TAN J,DEVRIESE P P,et al.Ambulatory pH measurements at the upper esophageal sphincter[J].Laryngoscope,1998,108:299-302.
[9]	EUBANKS T R,OMELANCZUK P E,MARONI-AN N,et al.Pharyngeal pH monitoring in 222patients with suspected laryngeal reflux[J].J Gastrointest Surg,2001,5:183-190.
[10]	李进让,孙建军.声带任克水肿[J].中国耳鼻咽喉头颈外科,2006,13(1):60-61.
[11]	MARTINS R H,DO AMARAL H A,TAVARES EL,et al.Voice Disorders:Etiology and Diagnosis[J].JVoice,2015,[Epub ahead of print]
[12]	KAMARGIANNIS N,GOUVERIS H,KATSIN-ELOS P,et al.Chronic pharyngitis is associated with severe acidic laryngopharyngeal reflux in patients with Reinke's edema[J].Ann Otol Rhinol Laryngol,2011,120:722-726.
[13]	CHUNG J H,TAE K,LEE Y S,et al.The significance of laryngopharyngeal reflux in benign vocal mucosal lesions[J].Otolaryngol Head Neck Surg,2009,141:369-373.
[14]	李进让,肖水芳,李湘平,等.咽喉反流性疾病诊断与治疗专家共识(2015年)解读[J].中华耳鼻咽喉头颈外科杂志,2016,51(5):327-332.
[15]	王嘉森,李晓雨,李进让.咽喉24h多通道腔内阻抗联合pH监测的临床应用[J].临床耳鼻咽喉头颈外科杂志,2015,29(2):190-193.
[16]	王嘉森,李进让,李晓雨,等.24h多通道腔内阻抗联合pH监测诊断咽喉反流的初步应用[J].中华耳鼻咽喉头颈外科杂志,2015,50(7):564-568.
[17]	李湘平,黄柞峰,吴婷,等.咽喉反流在声带白斑及早期声带癌发病中的初步观察[J].中华耳鼻咽喉头颈外科杂志,2014,49(5):362-367.
[18]	TOOHILL R J,KUHN J C.Role of refluxed acid in pathogenesis of laryngeal disorders[J].Am J Med,1997,103(5A):100S-106S.
[19]	DURSUN G,OZGURSOY O B,KEMAL O,et al.One-year follow-up results of combined use of CO₂ laser and cold instrumentation for Reinke's edema surgery in professional voice users[J].Eur Arch Otorhinolaryngol,2007,264:1027-1032.