74例咽喉反流患者抗反流黏膜切除术后2年临床疗效分析  

Analysis of the two-year clinical effectiveness of anti-reflux mucosectomy in 74 patients with laryngopharyn-geal reflux

作　　者：张斌[1] 陈升 李冰[1] 席晓宇 钟长青 高晓佩 李连勇[1] 隋昕珂[1] ZHANG Bin;CHEN Sheng;LI Bing;XI Xiaoyu;ZHONG Changqing;GAO Xiaopei;LI Lianyong;SUI Xinke(Department of Gastroenterology,the Ninth Medical Centerof Chinses PLA General Hospital,Beijing 100101,China)

机构地区：[1]中国人民解放军总医院第九医学中心消化内科,北京100101

出　　处：《山东大学耳鼻喉眼学报》2024年第6期120-125,130,共7页Journal of Otolaryngology and Ophthalmology of Shandong University

基　　金：战略支援部队特色医学中心博士毕业生科研启动基金(21ZX11)

摘　　要：目的 探索内镜下抗反流黏膜切除术(anti-reflux mucosectomy, ARMS)治疗咽喉反流性疾病(laryngopharyngeal reflux disease, LPRD)术后2年的临床疗效。方法 回顾性分析行ARMS手术并有随访结果的患者资料221例,所有患者通过口咽pH监测诊断LPRD,对比术前及术后2年的反流症状指数量表(reflux symptom index, RSI)、24hDx-pH监测结果,研究ARMS对LPRD的疗效,并以胃食管阀瓣(gastroesophageal flap valve, GEFV)级别分组,探讨GEFV对ARMS疗效的影响。结果 221例中共有74例患者纳入研究。RSI评分较术前降低(P=0.005),其中声嘶/发音障碍、持续清嗓、吞咽食物、水或药片不利、烧心、胸痛、胃痛好转最为明显(P=0.013,0.04,0.043,0.02)。Dx-pH监测结果,立位Ryan指数较术前降低(P<0.001)。GEFVⅠ、Ⅱ级患者术后立位Ryan指数较术前明显好转(P<0.05),卧位Ryan指数较术前无明显变化(P>0.05)。阀瓣Ⅲ、Ⅳ级患者术后立位Ryan指数、卧位Ryan指数均较术前无明显变化(P>0.05)。结论 ARMS手术可有效改善LPRD,阀瓣分级对判断预后有意义,Ⅰ、Ⅱ级患者症状改善尤其明显,阀瓣Ⅲ、Ⅳ级患者手术效果不明显。Objective To evaluate the two-year clinical efficacy of endoscopic anti-reflux mucosectomy(ARMS)in the treatment of laryngopharyngeal reflux disease(LPRD).Methods A retrospective analysis was performed on 221 patients who underwent ARMS and had available follow-up data.All patients were diagnosed with LPRD by oropharyngeal pH monitoring.Comparisons were made between pre-operative and two-year post-operative Reflux Symptom Index(RSI)scores and 24-hour Dx-pH monitoring results to assess the efficacy of ARMS in the treatment of LPRD.Patients were also grouped by gastroesophageal valve(GEFV)grade to investigate the influence of GEFV on ARMS efficacy.Results 74 out of 221 patients were included in the study.RSI scores decreased significantly compared to preoperative values(P=0.005),with the most notable improvements observed in hoarse-ness/voice disorders,persistent throat clearing,difficulty swallowing food,liquids or pills,heartburn,chest pain and stomach pain(P=0.013,0.04,0.043,0.02).According to the Dx-pH monitoring,the upright Ryan score decreased significantly compared to preoperative values(P<0.001).Patients with GEFV gradesⅠandⅡshowed a significant improvement in Ryan scores in the upright position postoperatively(P<0.05),while no significant changes were observed in Ryan scores in the supine position(P>0.05).In patients with GEFV gradesⅢandⅣ,no significant changes were observed in either the upright or supine Ryan scores postoperatively(P>0.05).Conclusion ARMS can effectively improve symptoms of LPRD and GEFV grading is valuable in predicting prognosis.Patients with GEFV gradesⅠandⅡshow significant symptom improvement,whereas patients with GEFV gradesⅢandⅣshow limited surgical benefit.

关 键 词：抗反流黏膜切除术 咽喉反流性疾病 阀瓣分级 Ryan指数 Dx-pH监测 

分 类 号：R766.14[医药卫生—耳鼻咽喉科]