质子泵抑制剂伏诺拉生联合曲安奈德局部注射治疗咽喉反流引起声带后联合肉芽肿的临床疗效分析

Clinical efficacy of the proton pump inhibitor vonoprazan combined with local injection of triamcinolone acetonide in treating posterior commissure granuloma caused by laryngopharyngeal reflux

摘要:

目的 探讨质子泵抑制剂伏诺拉生联合纤维电子喉镜下环甲膜局部注射曲安奈德治疗咽喉反流引起声带后联合肉芽肿的临床疗效。方法 选取2016年1月—2021年1月于徐州医科大学附属淮安医院就诊的咽喉反流阳性的声带后联合肉芽肿患者78例，随机分为实验组和对照组，实验组给予口服质子泵抑制剂伏诺拉生联合纤维电子喉镜下局部注射曲安奈德治疗，对照组单纯给予口服质子泵抑制剂伏诺拉生治疗，疗程结束后6个月和1年比较两组治愈率及复发情况。结果 实验组与对照组患者年龄、性别构成、患侧声带侧别构成、合并症发生率和病程比较，差异均无统计学意义（P >0.05）。治疗后6个月和1年，实验组疗效均优于对照组（P <0.05），复发率均低于对照组（P <0.05）。实验组与对照组治疗前、治疗后6个月和1年的食管下括约肌（LES）静息压力比较，结果 ①不同时间点LES静息压力比较，差异有统计学意义（F =9.738，P =0.017）；②实验组与对照组LES静息压力比较，差异有统计学意义（F =13.728，P =0.001），实验组LES静息压力较高；③两组LES静息压力变化趋势比较，差异有统计学意义（F =15.292，P =0.001）。实验组治疗前后胃蛋白酶的差值高于对照组（P <0.05）。结论 口服质子泵抑制剂伏诺拉生联合纤维电子喉镜下局部注射曲安奈德治疗声带后联合肉芽肿患者的临床疗效更好，复发率更低，能更有效地改善声带后联合肉芽肿患者的临床症状，且效果安全可靠。

Abstract:

Objective To evaluate the clinical efficacy of the proton pump inhibitor vonoprazan combined with transcricothyroid injection of triamcinolone acetonide under fiberoptic laryngoscopy in the treatment of posterior commissure granuloma caused by laryngopharyngeal reflux.Methods Seventy-eight patients with posterior commissure granuloma caused by laryngopharyngeal reflux treated at the Huai'an Hospital Affiliated to Xuzhou Medical University from January 2016 to January 2021 were selected. They were randomly divided into the experimental group and the control group, in which the experimental group was given the oral proton pump inhibitor vonoprazan combined with local injection of triamcinolone acetonide under fiberoptic laryngoscopy, and the control group was given the oral proton pump inhibitor vonoprazan alone. The cure rates and recurrence 6 and 12 months after the end of the treatment were observed and compared between the two groups.Results Comparison of age, sex composition, laterality of the affected vocal folds, comorbidity incidence and disease duration between the experimental group and the control group showed no statistically significant differences (P > 0.05). At 6 months and 1 year after treatment, the efficacy in the experimental group was better than that in the control group (P < 0.05), and the recurrence rate in the experimental group was lower than that of the control group (P < 0.05). Comparison of LES resting pressure in the experimental group and the control group before treatment, 6 months after treatment, and 1 year after treatment demonstrated that the LES resting pressure was different among the time points (F = 9.738, P = 0.017) and between the groups (F = 13.728, P = 0.001), where that in the experimental group was even higher compared with the control group. The change trend of LES resting pressure was also different between the two groups (F = 15.292, P = 0.001). The difference of pepsin levels before and after treatment in the experimental group was higher than that in the control group (P < 0.05).Conclusion Oral proton pump inhibitor vonoprazan combined with local injection of triamcinolone acetonide under fiberoptic laryngoscopy exhibits better clinical efficacy in treating patients with posterior commissure granuloma, resulting in a lower recurrence rate. This combination therapy effectively improves the clinical symptoms of patients with posterior commissure granuloma and is safe and reliable.