CO_2激光联合质子泵抑制剂治疗复发性声带突肉芽肿的疗效观察

Efficacy of CO_2 laser combined with proton pump inhibitors in the treatment of recurrent vocal process granuloma

目的 探讨CO2激光联合质子泵抑制剂治疗复发性声带突肉芽肿的疗效。方法 对复发性声带突肉芽肿患者28例,采用全麻支撑喉镜下CO2激光手术,其中有胃食管反流症状16例,胃食管反流症状不明确12例,术后应用质子泵抑制剂抗胃酸反流治疗8~12周,术后随访1年观察疗效。结果 28例术后声嘶、咽异物感等症状均有明显改善,病理证实均为肉芽组织。术后随访1年复查电子喉镜复发2例,给予埃索美拉唑40 mg/d口服1个月,肉芽肿明显缩小1例,肉芽肿未见进一步增大1例,无声嘶及异物感等喉部症状,未予再次手术治疗。结论胃食管反流是声带突肉芽肿术后复发的一个重要因素;CO2激光手术联合质子泵抑制剂是治疗复发性声带突肉芽肿的一个有效方法,创伤小、复发率低。

Objective To observe the therapeutic effect of CO2 laser combined with proton pump inhibitor in the treat-ment of recurrent vocal fold granuloma.Methods The clinical data of 28 cases of recurrent vocal process granuloma treated in our hospital were retrospectively analyzed.Of all cases,16 had gastroesophageal reflux symptoms,and 12 had no clear symptoms of gastroesophageal reflux.All patients underwent CO2 laser surgery under suspension laryngoscope, and then received anti acid reflux drug treatment with proton pump inhibitors for 8-12 weeks.Results The symptoms of hoarseness and foreign body sensationin all patients were obviously improved.The pathological results were granula-tion tissue.After one-year follow-up,all patients were examined with electron laryngoscope.The two recurrent cases orally took Esomeprazole 40 mg daily for one month.In one case,the granuloma significantly shrank;in the other case,the granuloma did not progress.Neither case received a second operation as they had no symptoms of hoarseness and foreign body sensation.Conclusion Acid reflux is an important factor of postoperative recurrence of vocal process granuloma;CO2 laser surgery combined with proton pump inhibitors is an effective treatment with advantages of small trauma and low recurrence rate.