支撑喉镜下环咽肌形态与咽喉反流关系的临床研究

目的 探讨显微喉手术中支撑喉镜下环咽肌呈现出的形态与咽喉反流症状间有无关联。方法 连续采集2013年8月—2014年10月海军总医院耳鼻咽喉头颈外科行显微喉手术治疗的147例患者的相关资料进行横断面研究,其中男96例、女51例,年龄15~71岁(中位年龄47岁)。根据反流症状指数量表(RSI)和反流体征量表(RFS)评分并分为2组:同时满足RSI>13分和RFS>7分者58例为反流组,其余89例为非反流组。在支撑喉镜下喉部手术结束时,将喉镜插入环后,暴露环咽肌,观察并按分型记录患者环咽肌形态,采用χ²检验进行组间比较。结果 147例患者中,3例环咽肌未暴露,其中反流组1例、非反流组2例;其余144例患者环咽肌暴露良好,反流组环咽肌暴露良好的57例中,半槛型36例(63.16%)、全槛型12例(21.05%)、平坦型9例(15.79%);非反流组环咽肌暴露良好的87例中,半槛型63例(72.42%)、全槛型11例(12.64%)、平坦型13例(14.94%)。两组患者环咽肌的形态差异无统计学意义(χ² =1.970, P>0.05)。结论 显微喉手术中支撑喉镜下观察环咽肌呈现出的形态与咽喉反流无关。

Morphology of cricopharyngeal muscle in suspension laryngeal endoscope and laryngopharyngeal reflux

Objective To determine whether laryngopharyngeal reflux (LPR) was associated with morphology of cricopharyngeal muscle (CPM) under suspension laryngoscope which is main part of upper esophageal sphincter. Methods The total of 147 consecutive patients (96 males and 51 females) aged from 15 to 71 years (medium, 47) who presented to our institution for endoscopic microlaryngoscopic surgery from August 2013 to October 2014 were prospectively studied. According to the reflux symptom index(RSI) and reflux finding score(RFS), RSI>13 and RFS>7, the subjects were divided into LPR group (58 patients) and non-LPR group (89 patients). The laryngoscope was introduced down to postcricoid area exposing mucosa-covered CPM just at end of endoscopic microlaryngoscopic surgery. The shape of CPM was recorded in three types, namely, semi-bar, full-bar and flat. Pearson χ² test was used for comparing the shape of CPM between LPR group and non-LPR group. Results CPM was exposed in 144 out of 147 subjects. There were 36 patients (63.16%, 36/57) as semi-bar, 12 patients (21.05%, 12/57) as full-bar and 9 patients (15.79%, 9/57) as flat in LPR group. And in non-LPR group, there were 63 patients (72.42%, 63/87) as semi-bar,11 patients (12.64%, 11/87)as full-bar and 13 patients(14.94%, 13/87) as flat. The shape of CPM had no differences between LPR group and non-LPR group(χ² =1.970, P>0.05). Conclusions The morphology of CPM in suspension laryngeal endoscope during microlaryngoscopic surgery is not related to LPR.