Department of Otorhinolaryngology-Head and Neck Surgery, German Armed Forces Hospital of Ulm, Oberer Eselsberg 40, 89081, Ulm, Germany.
Eur Arch Otorhinolaryngol. 2011 May;268(5):695-702. doi: 10.1007/s00405-010-1446-1. Epub 2010 Dec 9.
The objective of the study was to investigate the influence of anti-reflux medications on the management of periprosthetic leakage in laryngectomised patients with prosthetic voice rehabilitation. Sixty patients underwent laryngectomy and prosthetic voice rehabilitation. In a prospective non-randomised study, we examined the patients clinically and assessed the presence of reflux disease using 24-h dual-probe pH monitoring before and 6 months after oral anti-reflux treatment with proton pump inhibitors (PPIs). The severity of reflux, the effectiveness of anti-reflux therapy, and the clinical success of treatment were evaluated. Reflux parameters before and after anti-reflux therapy as well as the severity and incidence of periprosthetic leakage before and after PPI therapy were the main outcome measures. The absolute number of reflux events was 162.2 (±144.3) before treatment and 63.1 (±87.9) after treatment with PPIs (p = 0.031). The reflex area index score decreased from 327.1 (±419.3) without PPIs to 123.8 (±249.7) with PPIs (p = 0.0228). The mean DeMeester score was 108.3 (±85.4) before treatment and 47.4 (±61.7) after 6 months of treatment (p = 0.0557). The relative risk of periprosthetic leakage decreased to 0.5 after anti-reflux treatment. In 19 patients, leakage problems were successfully managed by rigorous treatment with PPIs. No further surgical procedures were required in these cases. Rigorous anti-reflux treatment leads to an improvement in parameters that can be assessed objectively by 24-h dual-probe pH monitoring. In the majority of patients, the symptoms associated with periprosthetic leakage can be improved or cured.
本研究旨在探讨抗反流药物对喉切除术后行人工发声重建患者假体周围漏管理的影响。60 例患者行喉切除术和人工发声重建。在一项前瞻性非随机研究中，我们对患者进行了临床检查，并在接受质子泵抑制剂（PPIs）口服抗反流治疗前后 6 个月使用 24 小时双探头 pH 监测评估反流疾病的存在。评估反流的严重程度、抗反流治疗的效果以及治疗的临床成功率。治疗前后的反流参数以及 PPI 治疗前后假体周围漏的严重程度和发生率是主要的观察指标。治疗前的反流事件绝对数为 162.2（±144.3），而治疗后的反流事件绝对数为 63.1（±87.9）（p=0.031）。无 PPI 时的反流面积指数评分从 327.1（±419.3）降至有 PPI 时的 123.8（±249.7）（p=0.0228）。治疗前的平均 DeMeester 评分是 108.3（±85.4），而治疗 6 个月后的平均 DeMeester 评分是 47.4（±61.7）（p=0.0557）。抗反流治疗后，假体周围漏的相对风险降低至 0.5。在 19 例患者中，通过严格的 PPI 治疗成功解决了漏液问题，这些患者无需进一步手术。严格的抗反流治疗可改善 24 小时双探头 pH 监测可客观评估的参数。在大多数患者中，与假体周围漏相关的症状可以得到改善或治愈。
