山东大学耳鼻喉眼学报 ›› 2016, Vol. 30 ›› Issue (5): 106-109.doi: 10.6040/j.issn.1673-3770.0.2016.073

• 论著 • 上一篇    下一篇

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观察

贾岩峰,杨春伟,宋富春,杨相立,王林,刘吉祥   

  1. 天津市人民医院耳鼻咽喉科, 天津 300121
  • 收稿日期:2016-02-26 出版日期:2016-10-20 发布日期:2016-10-20
  • 通讯作者: 刘吉祥. E-mail:jixiangliu6@hotmail.com E-mail:yanfengmaster@163.co
  • 作者简介:贾岩峰. E-mail:yanfengmaster@163.co

Efficacy of CO2 laser combined with proton pump inhibitors in the treatment of recurrent vocal process granuloma.

JIA Yanfeng, YANG Chunwei, SONG Fuchun, YANG Xiangli, WANG Lin, LIU Jixiang   

  1. Department of Otolaryngology, Tianjin Union Medical Centre, Tianjin 300121, China
  • Received:2016-02-26 Online:2016-10-20 Published:2016-10-20

摘要: 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。

关键词: 复发性, CO2激光, 质子泵抑制剂, 声带突肉芽肿, 胃食管反流

Abstract: Objective To observe the therapeutic effect of CO2 laser combined with proton pump inhibitor in the treatment 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 granulation 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.

Key words: Vocal process granuloma, Recurrence, CO2 laser, Gastroesophageal reflux, Proton pump inhibitors

中图分类号: 

  • R767.4
[1] Arroll T L, Gartner-Schmidt J, Statham M M, et al.Vocal process granuloma and glottal insufficiency: an overlooked etiology?[J]. Laryngoscope, 2010, 120(1):114-120.
[2] Ylitalo R, Ramel S. Extraesophagealreflux in patients with contract granuloma: a prospective controlled study [J]. Ann RhinolLaryngol, 2002, 111(5 Pt 1): 441-446.
[3] 张立红, 熊灵峰, 郑宏伟, 等. 双探头24小时监测对咽喉反流的诊断价值及特点[J]. 中国耳鼻咽喉头颈外科, 2012, 19(6): 322-323. ZHANG Lihong, XIONG Lingfeng, ZHENG Hongwei, et al.Diagnostic value and characteristics of 24 hours dual probe PH monitoring in patients with laryngopharyngeal reflux[J]. Chin Otolaryngol Head Neck Surg, 2012, 19(6):322-323.
[4] Lemos E M, Sennes L U, Imamura R, et al. Vocal process granuloma: clinical characterization, treatment and evolution[J]. Braz J Otorhinolaryngol, 2005, 71(4): 494-498.
[5] Martins R H, Dias N H, Santos D C, et al. Clinical, histological and electron microscopic aspects of vocal fold granulomas[J]. Braz J Otorhinolaryngol, 2009,75(1):116-122.
[6] Havas T E, Priestley J, Lowinger D S. A management strategy for vocal process granulomas[J]. Laryngoscope, 1999, 109(2 Pt 1):301-306.
[7] 侯丽珍,徐文,韩德民.喉接触性肉芽肿的临床特点[J].中国耳鼻咽喉头颈外科,2009,16(9):517-520. HOU Lizhen, XU Wen, HAN Demin.Clinical characteristics of laryngeal contact granuloma[J].Chin Otolaryngol Head Neck Surg, 2009, 16(9):517-520.
[8] Wong R K, Hanson D G, Waring P J, et al. ENT manifestations of gastroesophageal reflux [J]. Am J Gastroenterol, 2000, 95(8):S15-22.
[9] Habermann W, Kiesler K, Eherer A, et al.Short-term therapeutic trial of proton pump inhibitors in suspected extraesophageal reflux[J]. J Voice, 2002, 16(3):425-432.
[10] 孙欣,王瑾,柳斌.吸入性糖皮质激素联合质子泵抑制剂治疗声带突肉芽肿的疗效[J].中国医科大学学报,2012,41(1):94-95. SUN Xin, WANG Jin, LIU Bin.Inhaled glucocorticoid with proton pump inhibitor for treatment of vocal process granulomas[J]. J Chin Med Univ, 2012, 41(1):94-95.
[11] 邹剑,郑义涛,周光耀,等.声带突肉芽肿32例临床治疗分析[J].西部医学,2013,25(11):1666-1668. ZOU Jian, ZHENG Yitao, ZHOU Guangyao, et al.Analysis of treatment of vocal process granulomas[J].Med J West Chin, 2013, 25(11):1666-1668.
[12] 中华医学会消化病学分会.2014年中国胃食管反流病专家共识意见[J].中华消化杂志,2014,34(10):649-661. Chinese Society of Gastroenterology.Consensus of Chinese experts on gastroesophageal reflux disease in 2014[J]. Chin J Digestion, 2014, 34(10):649-661.
[13] 李兆生,许海波, 洪燕丽,等.4例胃食管反流致声带突肉芽肿的诊断和治疗[J].临床耳鼻咽喉头颈外科杂志,2015,29(14):1284-1287. LI Zhaosheng, XU Haibo, HONG Yanli, et al.Diagnosis and treatment of vocal process granuloma induced by gastroesophageal reflux: four cases report[J].Clin J Otorhinolarynol Head Neck Surg, 2015, 29(14):1284-1287.
[14] Lee S W, Hong HJ, Choi S H, et al.Comparison of treatment modalities for contact granuloma: a nationwide multicenter study[J].Laryngoscope, 2014, 124(5):1187-1191.
[15] 张建辉,唐嗣泉,唐一萍.喉接触性肉芽肿临床分析及治疗方法探讨[J].临床耳鼻咽喉头颈外科杂志,2014,28(6):416-418. ZHANG Jianhui, TANG Siquan, TANG Yiping.The clinical analysis and treatment of contact granuloma of larynx[J]. Clin J Otorhinolarynol Head Neck Surg, 2014, 28(6):416-418.
[16] Hong-Gang D, He-Juan J, Chun-Quan Z,et al.Surgery and proton pump inhibitors for treatment of vocal process granulomas[J].Eur Arch Otorhinolaryngol, 2013, 270(11):2921-2926.
[17] 刘晖,王晋平,杨颖,等.喉接触性肉芽肿15例诊治分析[J].中国临床医学,2012,19(6):672-673. LIU Hui, WANG Jinping, YANG Ying, et al. Laryngeal contact granuloma: a report of 15 cases[J]. Chin J Clin Med, 2012, 19(6):672-673.
[18] 倪鑫,马丽晶,韩德民,等.喉接触性肉芽肿的治疗[J].中国耳鼻咽喉头颈外科,2007,14(2):79-80. NI Xin, MA Lijing, HAN Demin, et al.The treatment of contact granuloma of larynx[J]. Chin Otolaryngol Otolaryngol Head Neck Surg, 2007, 14(2):79-80.
[19] 叶成刚,罗宇鸿,李伟利,等.肉毒素-A在难治性喉接触性肉芽肿的治疗应用[J].湖北科技学院学报(医学版),2015,29(1):46-48. YE Chenggang, LUO Yuhong, LI Weili, et al.The application of botulinum toxin-A in the treatment of refractory laryngeal contact granuloma[J].J Hubei Univ Sci Technology(Med Sci), 2015, 29(1):46-48.
[20] 和小颖,娄卫华.低温等离子治疗喉接触性肉芽肿的疗效分析[J].河南医学研究,2015,24(2):56-57. HE Xiaoying, LOU Weihua. The analysis of curative efficacy on laryngeal contact granuloma treated by low temperature plasma [J].Henan Med Research, 2015, 24(2):56-57.
[1] 陈鸣,俞雪飞. 浅谈伴有变应性鼻炎的慢性鼻窦炎的治疗[J]. 山东大学耳鼻喉眼学报, 2018, 32(3): 18-22.
[2] 郝艳,李栋才,蓝建平. CO2激光显微手术与传统显微手术切除声带息肉疗效比较[J]. 山东大学耳鼻喉眼学报, 2017, 31(6): 68-70.
[3] 薛建军. CO2激光治疗舌根部肿物18例[J]. 山东大学耳鼻喉眼学报, 2016, 30(6): 61-62.
[4] 马玲国,郑朝攀,周敬淳,张博,龚桃根,张云静. CO2激光治疗声门型喉癌远期疗效分析[J]. 山东大学耳鼻喉眼学报, 2016, 30(5): 98-100.
[5] 王晓燕,郑燕青,郑昊,叶青. 脉冲CO2激光与Er:YAG激光中耳骨消融的实验研究[J]. 山东大学耳鼻喉眼学报, 2016, 30(4): 75-79.
[6] 李泽文,郭俊宇,周洁,严福波,杨志敏,丁珠华. 胃食管反流病与喉癌关系的Meta分析[J]. 山东大学耳鼻喉眼学报, 2016, 30(3): 40-46.
[7] 杜志宏,于亚峰. NLRP3炎性小体在嗜酸粒细胞性鼻息肉发病及复发中的作用[J]. 山东大学耳鼻喉眼学报, 2016, 30(1): 31-35.
[8] 耿阳, 王惠忠, 孙丰林, 王孝, 王海鹏, 许荣, 夏拥军. CO2激光治疗声门下淀粉样变2例并文献复习[J]. 山东大学耳鼻喉眼学报, 2015, 29(2): 70-73.
[9] 王卫之1,张丙峰2,刘少华1,王欣2. 系统性糖皮质激素+沙利度胺治疗口咽部重型阿弗他溃疡[J]. 山东大学耳鼻喉眼学报, 2013, 27(6): 72-73.
[10] 李俐华,任基浩, 殷团芳,刘伟. 儿童复发性呼吸道乳头状瘤组织中STAT3、VEGF的表达及微血管密度测定与复发、侵袭的关系[J]. 山东大学耳鼻喉眼学报, 2011, 25(6): 11-.
[11] 伊海金1, 张宝泉2, 王春红1, 郭泓1, 倪富强1. 喉癌治疗后复发的临床因素分析及治疗[J]. 山东大学耳鼻喉眼学报, 2011, 25(3): 18-21.
[12] 於子卫,董频,庞正. 西妥昔单抗联合术后同步放化疗治疗晚期复发性头颈癌的初步观察[J]. 山东大学耳鼻喉眼学报, 2010, 24(6): 44-46.
[13] 欧阳天斌综述,唐世雄审校. 咽喉反流疾病发病机制及诊断的相关进展[J]. 山东大学耳鼻喉眼学报, 2010, 24(5): 48-51.
[14] 刘静波,黄建民,刘建治. 伴气管狭窄的复发性多软骨炎3例[J]. 山东大学耳鼻喉眼学报, 2010, 24(3): 54-56.
Viewed
Full text


Abstract

Cited

  Shared   
  Discussed   
No Suggested Reading articles found!