CAJ | 학술논문

目的：研究声带白斑及早期声带癌的咽喉反流情况。方法2012年12月至2014年1月收集南方医科大学南方医院因声带白斑及声带癌（ T1、T2）拟行手术治疗的患者，术前进行抽烟、饮酒等生活史采集，24小时多通道腔内阻抗-pH监测，并设16例健康成人对照组比较。结果声带癌组19例患者咽喉反流阳性5例（26.3％），声带白斑组17例患者咽喉反流阳性6例（35.3％），对照组2例（12.5％）。声带癌组、声带白斑组咽喉酸反流次数、酸反流时间和酸清除时间与对照组比较，差异均有统计学意义（ P值均＜0.05）；但咽喉反流阳性率差异均无统计学意义（ P值均＞0.05）。声带癌组胃食管反流阳性5例（26.3％），声带白斑组4例（23.5％），对照组1例（6.3％）。声带癌组DeMeester评分较对照组差异有统计学意义（ P＜0.05），胃食管反流阳性率差异无统计学意义（ P＞0.05）；声带白斑组DeMeester评分、胃食管反流阳性率与对照组比较差异均无统计学意义（ P值均＞0.05）。监测三组反流事件均以立位酸和弱酸性反流为主，反流物性质以酸性和弱酸性反流为主。声带白斑组立位弱碱反流、卧位酸反流、卧位弱碱反流次数均较对照组明显增加（P值均＜0.05），而在声带癌组中，无论是立位或卧位反流物的性质均与对照组差异无统计学意义（ P值均＞0.05）。声带癌和声带白斑患者发生咽喉反流、胃食管反流与吸烟史、饮酒史均未发现相关关系（ P值均＞0.05）。结论声带白斑及早期声带癌患者咽喉反流阳性比率较高，但反流与声带癌变的相关性缺少统计学支持，需进一步扩大样本论证。应重视反流内容物非酸反流对声带黏膜的损伤。
목적：연구성대백반급조기성대암적인후반류정황。방법2012년12월지2014년1월수집남방의과대학남방의원인성대백반급성대암（ T1、T2）의행수술치료적환자，술전진행추연、음주등생활사채집，24소시다통도강내조항-pH감측，병설16례건강성인대조조비교。결과성대암조19례환자인후반류양성5례（26.3％），성대백반조17례환자인후반류양성6례（35.3％），대조조2례（12.5％）。성대암조、성대백반조인후산반류차수、산반류시간화산청제시간여대조조비교，차이균유통계학의의（ P치균＜0.05）；단인후반류양성솔차이균무통계학의의（ P치균＞0.05）。성대암조위식관반류양성5례（26.3％），성대백반조4례（23.5％），대조조1례（6.3％）。성대암조DeMeester평분교대조조차이유통계학의의（ P＜0.05），위식관반류양성솔차이무통계학의의（ P＞0.05）；성대백반조DeMeester평분、위식관반류양성솔여대조조비교차이균무통계학의의（ P치균＞0.05）。감측삼조반류사건균이립위산화약산성반류위주，반류물성질이산성화약산성반류위주。성대백반조립위약감반류、와위산반류、와위약감반류차수균교대조조명현증가（P치균＜0.05），이재성대암조중，무론시립위혹와위반류물적성질균여대조조차이무통계학의의（ P치균＞0.05）。성대암화성대백반환자발생인후반류、위식관반류여흡연사、음주사균미발현상관관계（ P치균＞0.05）。결론성대백반급조기성대암환자인후반류양성비솔교고，단반류여성대암변적상관성결소통계학지지，수진일보확대양본론증。응중시반류내용물비산반류대성대점막적손상。
Objective To explore the significance of laryngopharyngeal reflux ( LPR ) and gastroesophageal reflux ( GER) in patients with vocal cord leukoplakia and early glottic cancer .Methods Patients with vocal cord leukoplakia and early glottic cancer encountered in Nanfang Hospital between December 2012 to January 2014 were included in this study .Ambulatory 24 hour multichannel intraluminal impedance-pH monitoring ( MII-pH ) was applied to obtain LPR and GER events , as well as the reflux properties of substances .Tobacco and alcohol history was also evaluated .Sixteen healthy volunteers were recruited as normal controls .Results There were 26.3% ( 5/19 ) LPR patients in glottic cancer group , 35.3%(6/17) LPR patients in vocal cord leukoplakia group and 12.5%(2/16) LPR volunteers in normal controls.There was no statistically significant difference in the positive rate of LPR between early glottic cancer patients and normal controls as well as between vocal cord leukoplakia patients and normal controls (P>0.05).There was statistically significance in numbers of acid reflux events , time of acid exposure, and time of acid clearance between vocal cord leukoplakia patients and normal controls as well as between glottic cancer patients and normal controls ( P <0.05 ).GER was found in 26.3% ( 5/19 ) patients in glottic cancer group and 23.5%( 4/17 ) patients in vocal cord leukoplakia group and 6.3% ( 1/16 ) volunteer in normal controls.There was no statistically significant difference in the positive rate of GER between early glottic cancer patients and normal controls as well as between vocal cord leukoplakia patients and normal controls ( P>0.05).However , there was statistically significance in DeMeester scores between glottic cancer patients and normal controls (P<0.05), while no statistically significance between vocal cord leukoplakia patients and normal controls ( P>0.05 ).Reflux events were dominated by acid and weakly acidic reflux in upright position.Weakly alkaline reflux events in upright position , acid reflux events in supine position , and weakly alkaline reflux events in supine position in vocal cord leukoplakia patients were significantly more than those in normal controls (P<0.05).No statistically significant difference existed in positions and contents between early glottic cancer patients and normal controls ( P>0.05).There was also no statistically significant correlation between happening LPR and GER , smoking and drinking in patients with vocal cord leukoplakia and early glottic cancer ( P>0.05 ).Conclusions Reflux events are more in vocal cord leukoplakia patients and early glottic cancer patients , however , the relationship between laryngopharyngeal reflux and canceration of the vocal cord is still needed to be invesgated .The significance of mucosal injury induced by nonacids refluxes is needed to be further studies .