艾司奥美拉唑治疗复发性声带肉芽肿的临床研究

Clinical study of esomeprazole in recurrent vocal granuloma

目的观察艾司奥美拉唑质子泵抑制剂治疗复发性声带肉芽肿的临床疗效。方法选取2017年6月至2019年12月在佛山市中医院耳鼻喉科就诊的声带肉芽肿患者28例,所有入选患者治疗前行反流症状指数量表评分及反流体征指数量表评分表,并行24 h食道咽喉pH监测,同时记录咽喉部胃酸反流情况,确诊后给予艾司奥美拉唑肠溶片20 mg口服,2次/d,持续8周或12周,疗程结束后随访3个月,并再次行反流症状指数量表评分和反流体征指数量表评分,复查24 h食道咽喉pH监测。结果①治疗前28例患者咽喉反流症状指数(RSI)量表平均评分18分;反流体征评分量表(RFS)平均评分13分,治疗后28例患者RSI平均评分9分,RSF平均评分4,经Fisher精确检验,RSI及RFS治疗前后差异有统计学意义(P<0.05)。②28例患者治疗前后直立位及仰卧位酸暴露次数和酸暴露时间差异有统计学意义(P<0.05),最长反流时间差异无统计学意义(P>0.05)。③经治疗后8周后18例患者肉芽肿消失,12周后22例患者肉芽肿消失。3例患者肉芽肿未能完全消失,再次选择激光手术治疗。结论声带肉芽肿患者和咽喉反流有一定的关系,抑酸剂治疗咽喉反流的声带肉芽肿患者取得了较好的疗效,可为患者避免手术的创伤。

【Objective】To investigate the efficacy of esomeprazole in the treatment of recurrent vocal granuloma.【Methods】Twenty-eight patients with recurrent vocal granuloma were enrolled from June 2017 to February 2019 in ENT department of the Traditional Chinese Medicine Hosptital of Foshan.All the patients were evaluated by reflux symptom index(RSI)and reflux finding score(RFS).The 28 patients were performed 24-hour pH monitoring of esophagus and pharynx and diagnosed laryngopharyngeal reflux,then took esomeprazole 20 mg two times per day for 8 or 12 weeks.All the patients were evaluated by RSI and RFS and performed 24-hour pH monitoring of esophagus and pharynx after 3-month follow up.【Results】The average RSI score was 18 points before treatment,while the average RSI score was 9 points after treatment.The average RSF score was 13 points before treatment,the average RSF score was 4 points after treatment.Fisher's accurate test showed there were significant differences between them before and after treatment(P<0.05).There were significant statistical differences in acid exposure times and total time of acid exposure in the upright positions before and after treatment in 28 patients.In the supine positions before and after treatment,there were significant statistical differences in acid exposure times and total time of acid exposure also.While there was no significant statistical difference in the longest reflux time.Vocal granulomas disappeared in 18 patients after 8 weeks of treatment with esomeprazole.Vocal granulomas disappeared in 22 patients after 12 weeks of treatment.Three patients failed to completely disappear,were adopted laser surgery again.【Conclusion】Patients with vocal cord granuloma are related to laryngopharyngeal reflux.Acid inhibitors in the treatment of recurrent vocal cord granuloma has achieved good efficacy.It can protect the patients with vocal cord granuloma from surgical injury.