质子泵抑制剂抗胃酸反流治疗声带肉芽肿的疗效观察

Effect of proton pump inhibitor on gastric acid reflux in the treatment of vocal cord granuloma

目的探讨质子泵抑制剂(Proton pump inhibitors, PPI)抗胃酸反流治疗声带肉芽肿疗效。方法通过询问病史、电子喉镜检查结果,参照咽喉反流性疾病(Laryngopharyngeal reflux disease, LPRD)诊断评分标准指南,对照反流症状指数评分量表(Reflux symptom index, RSI)和反流体征评分量表(Reflux finding score, RFS)评分诊断标准,对RSI≥13分或/同时RFS≥7分,疑似由LPRD引发的声带肉芽肿共22例,男性16例,女6例;26~69岁,平均48岁。给予PPI抗胃酸反流治疗12周,治疗后1个月、3个月、6个月各复查一次电子喉镜,随访1年评估疗效。结果经PPI抗胃酸反流治疗22例患者,其中3个月内声带肉芽肿消失18例,声带肉芽肿明显缩小3例,声带肉芽肿无明显缩小1例;6个月内复发3例;复发及声带肉芽肿无明显缩小患者经手术切除,术后继续加用PPI治疗8周,随访三个月复查电子喉镜,未见再次复发。结论采用RSI及RFS量化评分方法诊断声带肉芽肿,避免了在临床诊疗过程中存在的认识不足、过度诊断等情况出现;PPI抗胃酸反流治疗对由LPRD引发的声带肉芽肿可作为首选治疗方法,治愈率高,患者容易接受,避免过度医疗给患者及家庭造成的精神压力和经济负担。

Objective To investigate the efficacy of proton pump inhibitors (PPI) in the treatment of vocal cord granuloma. Methods Referring to the diagnostic scoring standard guide of Laryngopharyngeal reflux disease (LPRD), the diagnostic criteria of Reflux Symptom Index (RSI) and Reflux Finding Scale (RFS) were compared by inquiring the medical history and the results of electronic laryngoscopy. There were 22 cases of suspected vocal cord granuloma caused by LPRD, 16 males and 6 females, aged 26~69 years, with an average of 48 years. PPI was given to treat gastric acid reflux for 12 weeks, and electronic laryngoscope was reexamined one month, three months and six months after treatment. The curative effect was evaluated after 1-year follow-up. Results Among 22 patients treated with PPI anti-acid reflux therapy, 18 cases disappeared within 3 months, 3 cases decreased significantly, 1 case did not shrink significantly, and 3 cases recurred within 6 months. The patients with recurrence and no obvious shrinkage of vocal cord granuloma underwent surgical excision, and continued to be treated with PPI for 8 weeks after operation. These patients were followed up. Their laryngoscope was reviewed monthly and no recurrence was found. Conclusions RSI and RFS quantitative scoring methods applied to the diagnosis of vocal cord granuloma, which can avoid the lack of understanding and overdiagnosis in clinical diagnosis and treatment. PPI anti-acid reflux therapy is the first choice for LPRD-induced vocal cord granuloma, which has high cure rate, easy acceptance. It can also be helpful on avoiding over-treatment, which will impose mental stress and financial burden on patients.