胃食管反流性喉痉挛的综合诊治:附64例报道

doi:10.3969/j.issn.1674-490X.2018.03.003

摘要/Abstract

摘要： 目的研究反流性喉痉挛(gastroesophageal reflux laryngospasm, GERL)的临床特点及其对综合诊治的反应。方法纳入2010年1月至2016年6月连续住院,症状问卷调查符合喉痉挛发作特点,胃镜、测压及24 h pH检查后行PPI、食管贲门射频治疗或胃底折叠术后喉痉挛症状消失,随访观察12个月以上喉痉挛无发作而诊断为GERL的患者,统计分析GERL患者的gastroesophageal reflux disease(GERD)症状谱,喉痉挛发作特点、检查结果及对抗反流治疗的反应。结果本研究共纳入GERL患者64例,平均年龄48.9岁。71.9%患者伴有反酸、烧心等典型GERD症状,75%的患者伴有咳嗽、哮喘等食管外症状。35.9%患者主诉反酸可致呛咳,继而出现喉痉挛, 73.4%的患者自觉餐后、进食刺激性食物、饱食或饮酒后喉痉挛多发,42.2%的患者喉痉挛多发于平卧睡眠中。24 h pH监测和胃镜检查的病理性酸反流和食管炎的检出率分别为53.1%和48.6%。本组有37.5%的患者对PPI的反应良好,51.6%有部分反应,10.9%对PPI反应不佳;84.4%的患者因不能停用PPI或PPI疗效不佳选择食管贲门射频治疗或胃底折叠术,取得了良好的疗效。结论喉痉挛可作为GERD的食管外表现之一。GERL患者可合并GERD的典型症状和/或食管外症状,部分患者可自觉喉痉挛发作与反流症状、饮食、体位等因素相关而有助于GERL的诊断。GERL通常对PPI、射频治疗和胃底折叠术等抗反流治疗反应良好。

关键词: 喉痉挛, 胃食管反流病, 质子泵抑制剂, 射频, 胃底折叠术

Abstract: Objective To study the clinical characteristics and the comprehensive diagnosis and treatment of gastroesophageal reflux larynspasm(GERL). Methods GERL patients with characteristics of laryngeal spasm by symptoms questionnaire selected from January 2010 to June 2016 were admitted continuous hospitalization; had excellent response to PPI, antireflux radiofrequency or fundoplication after gastroscopy, manometry and 24 hours pH examination; without laryngeal spasm episodes in follow-up of more than 12 months after antireflux therapy.The gastroesophageal reflux disease(GERD)symptom spectrum, characteristics of larynspasm attack, examination results, and response to antireflux treatment of the GERL patients were statistically analyzed. Results A total of 64 patients with GERL were included in the study, with an average age of 48.9 years. 71.9% of the patients had typical symptoms of GERD such as acid reflux and heartburn, 75% had other extraesophageal reflux symptoms such as cough and asthma. 35.9% of the patients complained regurgitation could cause choking cough and the following larynspasm, 73.4% reported of increased larynspasm episodes after meal, irritating food intake, over eating, or alcohol consumption, and 42.2% complained larynspasm was prone to occure in supine position during sleep. The detecting rates of pathological acid reflux and esophagitis by 24 h pH monitoring and gastroscopy were 53.1% and 48.6%, respectively. 37.5% of the patients had good response, 51.6% had partial response, and 10.9% had poor response to PPI therapy. 84.4% of the patients failed to stop or had no resopse to PPI converted to radiofrequency or fundoplication, and good results were achieved. Conclusion Larynspasm could one of the extraesophageal reflux manifestations of GERD, larynspasm could be combined with typical symptoms and/or extraesophageal symptoms of GERD. Part of the patients’ larynspasm onset is associated with reflux symptoms, diet and body position, which is helpful for the diagnosis of GERL. GERL usually responds well to antireflux therapy such as PPI, radiofrequency and fundoplication.

Key words: laryngospasm, gastroesophageal reflux disease, proton pump inhibitor, radiofrequence, fundoplication

中图分类号:

胡志伟,汪忠镐,吴继敏,纪涛,许辉,湛莹,辛荣华,梁艳,毛建新. 胃食管反流性喉痉挛的综合诊治:附64例报道[J]. 医学研究与教育, 2018, 35(4): 11-18.

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