双探头24小时pH监测对咽喉反流的诊断价值及特点

Diagnostic value and characteristics of 24 hours dual probe pH monitoring in patients with laryngopharyngeal reflux

目的对咽喉反流患者用食道测压定位法行双探头24小时pH监测,探讨其诊断价值及特点。方法对53例疑咽喉反流患者用食道测压定位法行双探头24小时pH监测同时用反流症状指数量表(reflux symptom index,RSI)、反流检查计分量表(reflux finding score,RFS)2个量表评估。结果 53例患者中31例咽喉反流阳性,与吸烟有相关性。RSI中以声嘶、咽异物感、持续清嗓为主要症状,RFS中以后连合增生、假声带沟、喉内黏液附着为主要体征。咽喉部酸反流主要发生在直立位,其中9例患者只有咽喉反流性疾病,10例只有胃食管反流性疾病;酸反流次数、酸暴露时间(即pH<4.0的总时间)与2个量表的评估有显著性差异。咽喉部pH监测结果与2个量表评估结果程度一致。结论咽喉反流性疾病可不伴发胃食管反流性疾病,减少酸反流次数及减少酸在咽喉部停留时间在治疗疾病中较为重要,RSI和RFS 2个量表可作为咽喉反流性疾病诊断的初筛。

OBJECTIVE To study the diagnostic value and characteristics of 24 hour dual probe pH monitoring in patients with laryngopharyngeal reflux disease.METHODS Ambulatory 24 hour dual probe pH monitoring were performed in 53 patients with suspected laryngopharyngeal reflux disease.The probes of the pH monitor were put to the esophogus and hypopharynx according to the results of esophageal manometry.The reflux symptom index（RSI）and reflux finding score（RFS）were assessed before the pH monitoring.RESULTS The main symptoms of the RSI lists were hoarseness,pharyngeal globus and persistent throat clearing.The main findings of the larynx were posterior commissure hypertrophy,pseudosulcus and thick endolaryngeal mucus.Thirty one cases got a positive result of laryngopharyngeal reflux.The events of laryngopharyngeal reflux were correlated with smoking.Laryngopharyngeal reflux occurred mainly in the upright position.There were 9 patients with laryngopharyngeal reflux disease only and 10 patients with gastroesophageal reflux disease only.Acid reflux events and acid exposure time（ie the total time of pH〈4）were not consistent with the results of RSI and RFS.Moderately consistence was found between the layngopharyngeal pH monitoring results and RSI,RFS results.CONCLUSION Laryngopharyngeal reflux disease could occur without gastroesophageal reflux disease.It is important to reduce the occurrence of acid reflux and the resident time of acid in the pharynx in the treatment of laryngopharyngeal reflux disease.RSI and RFS can be used as screening tools for diagnosis of laryngopharyngeal reflux disease.