反流引起的呼吸道表现:胃食管气道反流及其误诊误治

摘要

目的 探讨由胃食管反流引起的呼吸道表现,即胃食管气道反流 (gastroesophago-airway reflux, GEAR)的临床特点,分析误诊情况,总结微创治疗方法及效果.方法 收集第二炮兵总医院胃食管反流病中心2006年10月至2009年11月诊治的1014例胃食管反流病(gastroesophageal reflux disease, GERD),对以呼吸道症状为主要表现的766例诊治情况进行回顾分析.结果 本组呼吸道症状依次为喘息、憋气、咳嗽、咽异物感、咳痰、喉部发紧等.741例(96.7%)在外院误诊为哮喘、慢性支气管炎、慢性咽炎等.其中误诊为呼吸道疾病患者3个年龄段比较差异有统计学意义,以41～60岁最多.均在本中心经胃镜检查和食管24小时pH监测、试验性药物治疗,确诊为GERD.改良的Stretta 射频治疗392例,372例获随访24～44个月,总有效率94.9%.行腹腔镜 Nissen 胃底折叠术262例,214例随访4～20个月,总有效率91.1%.112例接受质子泵抑制剂等药物治疗.结论 临床应全面认识GERD, 尤其注意口鼻、咽喉和气道、肺部的临床表现,其病因可以是由各种原因引起的食管反流,我们将其统称为GEAR,而由其引起的这组临床表现则建议称为胃食管气道综合征.误诊的纠正本身就可使病情改善,经过合理的治疗有望得到更好疗效,为患者带来新生.%Objective To explore the airway presentations induced by gastroesophago-airway reflux (GEAR), analyze misdiagnosis and discuss less invasive approach and its efficacy. Methods 1014 patients with gastroesophageal reflux disease (GERD) treated in the GERD Center of the Second Artillery General Hospital of PLA from October 2006 to November 2009 were enrolled, among whom, the clinical data of 766 patients with mainly respiratory symptoms was retrospectively analyzed. Results Respiratory symptoms in this group were mostly wheezing, breathlessness, cough, phlegm, pharyngeal lump sensation, laryngeal tightening, and so on. 741 cases (96.7％) were misdiagnosed as asthma, chronic bronchitis,chronic pharyngitis, etc before admission. The patients misdiagnosed as airway disorders in three age segments had statistical difference, and mostly showed between 41 ～ 60 years of age. All patients were diagnosed as GEAR by gastroscopy, 24hour pH monitoring, and experimental treatment. 392 patients were treated with modified Stretta radio-frequency, among whom, 372 cases were followed up for 24 to 44 months, and the total effective rate was 94.9％. 262 patients were treated with Laparoscopic Nissen fundoplication, among them, 214 were followed up 4 to 20 months, and the total effective rate was 91.1％. 112 patients received PPI treatment. Conclusion Overall understanding GERD clinically, with particular attention to the fact that the etiology of compromises in the rhino-oral cavity, throat, trachea as well as lungs is due to esophageal reflux, so as to establish the correct diagnosis and avoid misdiagnosis. This reflux is called GEAR, and this group of clinical presentations is expected to be nominated as gastro-esophago-airway reflux (GEAS). The correction of misdiagnosis itself can relieve symptoms and appropriate method of treatment can bring out better improvement or even a new life for the patient.