胃食管喉气管反流及其综合征  

Gastroesophago-larygotracheal Reflux and Its Syndrome

作　　者：汪忠镐[1] 吴继敏 谭松涛[3] 季峰[1] 来运钢[1] 高翔[1] 张成超[1] 宁亚婵[1] 李治仝[1] 陈秀 

机构地区：[1]首都医科大学宣武医院胸心血管外科,北京100053 [2]解放军二炮总医院胃食管反流中心,北京100088 [3]广东武警总医院胃食管反流中心,广州510507

出　　处：《临床误诊误治》2010年第S1期1-5,共5页Clinical Misdiagnosis & Mistherapy

摘　　要：胃食管反流病(gastreoesophageal reflux disease,GERD)即胃十二指肠内容物反流入食管,引起反酸、胃灼热、反食、嗳气等症状,它可导致食管组织损害。咽喉反流(laryngopharygeal reflux,LPR)为胃内容物反流至咽喉部,引起慢性咽喉炎、声音嘶哑、咽异物感、频繁清嗓、慢性咳嗽、吞咽困难等临床表现。胃食管喉气管反流(gastroesophago-larygotracheal reflux,GELTR)则是发自贲门部,以咽喉部为反应中心,以气道表现尤其是哮喘、喉气道激惹为突出点,涉及呼吸、消化两大系统及耳鼻口腔的反流性疾病,即以胃食管交接处为启动器、以咽为反应器、以口鼻为效应器,以喉气道为喘息发生器的一种临床症候群———胃食管喉气管综合征(gastroesophago-larygotracheal syndrome,GELTS),可表现为严重"哮喘"、喉部发紧、咳嗽、咳痰和声音嘶哑、听力障碍等症状体征。此类患者多长期误诊,一旦得到正确诊断,即能得到希望以至新生。本文以罕见的食管、气管和双下支气管系统同时被钡剂充盈的图像等为依据,从LPR探讨胃食管喉气管反流及其综合征的发病机制、诊断与治疗问题,并提出了在生理情况下呈闭合状态和经咽反流的鸟嘴机制,以及由溢出或淤出(spilling)、涌出或呕出(spurting)和喷射或气雾(spraying)组成的"3S"现象。Gastroesophageal reflux disease is a disorder,caused by regurgitating of the duodenal and gastric contents into the esophagus,resulting in acid regurgitation,heartburn,eructation,and injury of the esophageal tissues.Laryngopharygeal reflux is a disorder caused by the same contents regurgitating into throat,causing chronic pharyngolaryngitis,hoarseness,foreign bodies sensation,throat clearing,chronic cough and dysphagia.Gastroesophageal-laryngotracheal reflux is a syndrome,initiated in the cardia and reacting in the laryngopharynx and involving both the respiratory and digestive systems,the ear,nose,and oral cavity.It is mainly characterized by asthma and larynx airway irritation.However it may appear with neither heartburn nor acid regurgitation in some cases.The hypothesis of gastroesophago-laryngotracheal syndrome(GELTS) is represented by a group of clinical menifestations occurring in the gastroesophageal junction as the generator,the pharynx as the reactor,the rhino-oral cavity as effector,the larynx and respiratory tract as asthmatic producer.The patients may suffer from severe asthma,throat tightness,severe cough,expectoration,hoarseness and dysaudia.Correct diagnosis may bring new hopes and even save the patient's life.The article presents images of esophagus,bilateral lower airways simultaneously filled by barium,which are used as basis to explore pathogenesis,diagnosis and treatment of GELTR from a LPR perspective.A trans-physically-closed pharynx reflux caused "3S" phenomenon(spilling,spurting and spraying)is raised.

关 键 词：胃食管反流病 咽喉反流 胃食管喉气管综合征 

分 类 号：R571[医药卫生—消化系统]