声带白斑与胃食管咽喉反流的相关分析

Relationship between vocal fold leukoplakia and gastropharyngeal reflux：analysis of 15 cases

目的探讨声带白斑与胃食管咽喉反流可能的相关性。方法选取2007年3月至2008年2月诊断为声带白斑，并由术后病理证实为声带角化伴或不伴不典型增生患者15例，征得患者同意后手术前行24h咽喉及食管pH监测，统计反流率，分析反流特点、反流症状评分。结果15例患者中有病理性食管内反流者9例，阳性率为60％，食管反流阳性组与反流阴性组之间在反流时间（104．6min±42．1min／10．9min±11．5min）、反流次数（30．1次±16．2次／4．8次±3．4次）、反流百分率（7．9％±2．9％／1．0％±0．6％）差异均有统计学意义（t值分别为-0．585，-4．029，-6．095，均P〈0．01），在反流症状评分方面，组间反酸烧心症状差异有统计学意义（P〈0．05）。病理性咽喉部反流2例，反流概率13．3％，其中1例同时患有阻塞性睡眠呼吸暂停低通气综合征。结论声带白斑患者较普通人群有较高的病理性食管反流概率，反流可能是声带黏膜发生白斑病变的危险因素之一。

Objective To explore the possible relationship between vocal fold leukoplakia and gastropharyngeal reflux. Methods Fifteen patients with vocal fold leukoplakia confirmed by pathology, all males, aged （53 ± 14） （20 -88）, underwent esophageal and laryngopharyngeal 24-hour pH monitoring before operation. The rate and characteristics of reflux were recorded. Semi-open-ended questionnaire was used to assess the symptoms. Results Nine of the 15 patients （60%） showed pathologic intra-esophageal reflux. The time of total acid reflux of the positive re intra-esophageal reflux group was 104. 6 min ± 42. 1 min, significantly longer than that of the negative group [ （ 10. 9 min ± 11.5 min ） , P = 0. 001 ] . The frequencies of intra-esophageal acid reflux of the positive group was （30. 1 ± 16. 2） times, significantly higher than that of the negative group [ （ 4. 8 ± 3.4 ） times, P = 0. 006 ]. The intra-esophageal acid reflux percentage of the positive group was 7.9% ± 2. 9%, significantly higher than that of the negative group [ （ 1.0% ± 0. 6% ） , P = 0.01 ]. and the rate in esophageal pH 〈 4 of total fraction time between reflux positive and negative patients（ P 〈0. 01 ）. The scores of heartburn and acid regurgitaion of the positive group were significantly higher than those of the negative group （ both P 〈 0. 05 ）. Two of 15 patients （ 13.3% ） had pathologic laryngopahryngeal reflux. One patient also had obstructive sleep apnea hypopnea syndrome. Conclusion The patients with vocal fold leukoplakia had more pathologic intra-esophageal reflux compared to the normal individuals. Reflux mav be a risk factor of mucosa leukoplakia.