4例胃食管反流致声带突肉芽肿的诊断和治疗

Diagnosis and treatment of vocal process granuloma induced by gastroesophageal reflux:four cases report

目的：探讨胃食管反流致声带突肉芽肿的发病机制、临床特点、诊断和治疗方法。方法：回顾分析4例典型声带突肉芽肿患者的病例资料。结果：4例均为成年男性,3例无明显胃部及食管症状,1例有胃胀、反酸史;4例均为左侧病变,均为试验性抑酸治疗而确诊;2例行手术治疗均复发;4例均行雷贝拉唑抑酸治疗,3例治愈,1例无效改用潘妥拉唑治疗而治愈;随访4~48个月,无复发。结论：胃食管反流是声带突肉芽肿一个重要的致病因素;多数声带突肉芽肿并无胃食管反流性症状,左侧病灶较多与睡眠体位有关,目前主要诊断依据以喉镜检查所见及试验性抑酸治疗为主;单纯手术治疗复发率高,抑酸治疗是主要方法,改换质子泵抑制剂药仍然有效,疗程要足够,同时要重视综合治疗。

Objective：To explore the mechanism,clinical characterization,diagnosis and therapeutic approach of vocal process granuloma（VPG）induced by gastroesophageal reflux.Method：We performed a retrospective review of 4cases.Result：In 4male cases,3cases had no obvious symptoms of stomach and esophagus and 1case had symptoms of bloating and acid reflux.Additionally,4cases in which lesions were all located to the left side were diagnosed by trial therapy with proton pump inhibitors（PPIs）with good responding.2of 4cases were relapsed after operations.Meanwhile 4patients were treated by Rabeprazole for acid suppression therapy and 3cases were cured and 1invalid case was cured by Pantoprazole.All patients were followed up for 4-48 months with no recurrence.Conclusion：Gastroesophageal reflux is an important pathogenic factor to the VPG.The majority of patients with VPG do not have gastroesophageal reflux symptoms.Besides,most lesions located in the left are associated with sleeping position.The diagnosis is mainly based on the laryngoscope examination and trial of acid suppression therapy.Moreover,recurrence risk is high-with simple operation in VPG therefore the main treatment is a antireflux and it is also valid by replacing byother PPI treatment.The treatment must be long enough.Meanwhile,the comprehensive treatment should be noticed.