Zhang Rui, Li Xiang-ping, Wang Lu, Wu Jia-nuan, Zeng Fang-fang, Li Yan-fei
Department of Otorhinolaryngology Head and Neck Surgery, Nanfang Hospital of Southern Medical University, Guangzhou 510515, China.
Zhonghua Er Bi Yan Hou Tou Jing Wai Ke Za Zhi. 2013 Jun;48(6):455-60.
Through monitoring esophageal dynamic change, and detection of laryngopharyngeal reflux(LPR) and gastroesophageal reflux events,to discuss the relationship of vocal cord polyps with laryngopharyngeal reflux.
Thirty-two patients with vocal cord polyps were diagnosed by electronic laryngoscopy in Nanfang Hospital between October 2011 to May 2012. This study applied high-resolution esophageal manometry (HRM) and ambulatory 24-hour multichannel intraluminal impedance-pH monitoring (MII-pH) to obtain the upper esophageal sphincter(UES) and lower esophageal sphincter pressure, characteristics of sectional esophageal motility; laryngopharyngeal reflux (LPR)and gastroesophageal reflux events, as well as the reflux properties of substances. Sixteen healthy volunteers were recruited as normal controls.
UES relaxation duration, duration of UES relaxation time, UES relaxation recovery time and mean length of LES were all shorter than those of the control group (t were 2.244, 2.624, 2.310 and -2.397, P < 0.05). There were 40.6% (13/32) LPR and 50.0% (16/32) gastroesophageal reflux found in vocal polyp patients. Median number (M [P25; P75]) of laryngopharyngeal acid reflux events were 0.5[0.0;3.5] and 0.0[0.0;0.0] in vocal polyp group and the controls, median mean time of laryngopharyngeal acid exposure 0.1[0.0;1.7] and 0.0[0.0;0.0] min, median clearance time of laryngopharyngeal acid were 3.5[0.0;53.5] and 0.0[0.0;0.0] s, median scores of DeMeester were 14.8[1.6;31.3] and 1.8[1.1;4.1] and median frequency of total liquid reflux episodes were 46.5[25.3;69.0] and 32.5[20.0;36.3], respectively. The median numbers of laryngopharyngeal acid reflux events, time of acid exposure, time of acid clearance, DeMeester scores and frequency of total liquid reflux episodes were increased or higher in vocal polyp group than those in the controls (z were 2.481, 2.767, 2.767, 2.344 and 1.980, P < 0.05).
There are upper esophageal sphincter and Lower esophageal sphincter dismotility in vocal polyp patients with LPR. LPR events were dominated by acid reflux in upright position.Esophageal dynamic disfunction and LPR should be considered in the study of the pathogenesis of vocal cords polyps.
通过监测食管动力学变化，检测咽喉反流（LPR）和胃食管反流事件，探讨声带息肉与咽喉反流的关系。
2011年10月至2012年5月间，南方医院通过电子喉镜诊断的32例声带息肉患者纳入本研究。本研究应用高分辨率食管测压（HRM）和24小时动态多通道腔内阻抗-pH监测（MII-pH），以获取食管上括约肌（UES）和食管下括约肌压力、食管节段性运动特征、咽喉反流（LPR）和胃食管反流事件，以及物质的反流特性。招募16名健康志愿者作为正常对照。
声带息肉患者的UES松弛持续时间、UES松弛时间、UES松弛恢复时间和LES平均长度均短于对照组（t分别为2.244、2.624、2.310和-2.397，P<0.05）。声带息肉患者中咽喉反流（LPR）发生率为40.6%（13/32），胃食管反流发生率为50.0%（16/32）。声带息肉组和对照组咽喉部酸反流事件中位数（M[P25；P75]）分别为0.5[0.0；3.5]和0.0[0.0；0.0]，咽喉部酸暴露平均时间中位数分别为0.1[0.0；1.7]和0.0[0.0；0.0]分钟，咽喉部酸清除时间中位数分别为3.5[0.0；53.5]和0.0[0.0；0.0]秒，DeMeester评分中位数分别为14.8[1.6；31.3]和1.8[1.1；4.1]，总液体反流发作频率中位数分别为46.5[25.3；69.0]和32.5[20.0；36.3]。声带息肉组咽喉部酸反流事件、酸暴露时间、酸清除时间、DeMeester评分和总液体反流发作频率的中位数均高于对照组（z分别为2.481、2.767、2.767、2.344和1.980，P<0.05）。
合并LPR的声带息肉患者存在食管上括约肌和食管下括约肌运动功能障碍。LPR事件以直立位酸反流为主。在声带息肉发病机制研究中应考虑食管动力学功能障碍和LPR因素。
