PPI联合胃动力药与肉毒素注射治疗声带突肉芽肿疗效的比较研究

A comparative study of therapy effects between esomeprazole plus mosapride citrate and botulinum toxin injection on vocal process granuloma

目的:针对确诊的声带突肉芽肿,进行质子泵抑制剂(PPI)联合胃动力药物治疗与支撑喉镜下肉毒素注射治疗的对照研究,分析比较2种方法治疗声带突肉芽肿的有效性,以及对患者咽喉部症状和体征的缓解情况。方法:选取2014-12-2016-06期间就诊并符合纳入条件的38例声带突肉芽肿患者,根据患者的治疗意愿分为PPI联合胃动力药物组(28例,其中10例为肉毒素注射失败患者)及肉毒素注射治疗组(20例)。用症状指数量表及体征评分量评估患者治疗前后的症状及体征。结果:2组患者的年龄、性别、病程之间差异无统计学意义。PPI联合胃动力药物治疗的总有效率为96.43%;肉毒素注射组总有效率为45.00%。治疗前2组患者反流症状指数量表及咽喉反流体征量表评分差异无统计学意义;肉芽肿完全消失、复发时,2组患者反流症状指数量表及咽喉反流体征量表评分之间差异有统计学意义。结论:PPI联合胃动力药物治疗声带突肉芽肿的有效率及患者咽喉部症状和体征缓解率较肉毒素注射明显要高。

Objective： Anti-reflux medications or botulinum toxin A injections are the main current therapies for the definite vocal process granuloma. This studies is focusing on comparing the effects of proton pump inhibitors plus prokinetic agents with botutinum toxin A injections on vocal process granutoma. Method： Adult patients in our outpatient department （from December 2014 to June 2016） complaining of trachyphonia and/or abnormal pha- ryngeal sensations who were found to have contact granulomas（38 cases） were included. Patients were divided into two groups according to the treatment selected by themselves： esomeprazole with mosapride citrate（n= 28） or botulinum toxin A injection（n= 20）. The reflux symptom index and reflux finding score determined by electronic fi- brolaryngoscopy were utilized to assess efficacy. Result：There was no statistical difference on age , sex and reflux symptom index and reflux finding score before treatment between the two groups. Total effective ratein of the es- omeprazole with mosapride citrate group and the botulinum toxin A group were 96.43% and 45.00% ,separately. The recorded symptoms after therapy resolved with a statistically significant improvement in the esomeprazole with mosapride citrate group. Conclusion：Combined proton pump inhibitor plus prokinetic drug therapy plays a significant role in the treatment of vocal process granulomas.