胃食管反流相关呼吸疾病及其外科治疗策略

摘要

胃食管反流(gastroesophageal reflux,GER)相关性呼吸疾病是一个涉及消化、呼吸、耳鼻喉、口腔乃至血管外科等多学科的疾病实体.研究证实胃食管反流病在哮喘、慢性咳嗽、慢性耳鼻喉炎性疾病以及某些进行性甚至晚期呼吸疾病,包括特异性肺纤维化、支气管扩张、囊性纤维化、慢性阻塞性肺疾病、硬皮病等疾病中的合并率明显高于普通人群,这些人群还普遍存在微吸入.高位反流物经咽喷射是造成微吸入及其呼吸道侵袭的重要原因,故可将GER相关呼吸疾病视为抗反流治疗可有效控制的疾病实体.目前研究显示质子泵抑制剂相对安慰剂虽无明显疗效,但仍把它推荐作为经验性或实验性药物用于很好选择过的患者.手术治疗作为一个更全面有效的抗反流手段在绝大多数的研究中显示了对GER相关呼吸疾病良好的治疗效果,也从另一个层面证明了GER与部分呼吸疾病存在密切联系,但其因果关系尚未阐明.手术治疗仍有部分患者效果不佳或无效,提示如何准确选择手术适应证以及如何进一步提高疗效仍需大量的研究.%Related respiratory diseases of gastroesophageal reflux (GER) are involved in multidisciplinary disease entities including gastroenterology,respiratory,otorhinolaryngology,stomatology and cardiovascular surgery.Gastroesophageal reflux disease (GERD) has a significantly high combination rate in various chronic respiratory diseases,such as asthma,chronic cough,chronic ENT inflammatory diseases,and even in late stage of some respiratory diseases including idiopathic pulmonary fibrosis,bronchiectasis,cystic fibrosis,chronic obstructive pulmonary disease (COPD) and scleroderma compared with common people,whose micro-aspiration are common.Trans-pharyngeal spraying of refluxing in high position is an important cause of micro-imbibition and respiratory tract invasion,so GER related respiratory diseases should be considered as controllable entities of antireflux therapy.Up to date,proton pump inhibitor (PPI) has not shown significant therapeutic effect compared with that by placebo in asthma control; however PPI therapy is still recommended in well selected patients with asthmatic.Serving as a more radical therapy,surgical intervention has been proved more effective in treatment of GER related respiratory diseases in the overwhelming majority of studies,which can prove in another part that GER has a close connection with some respiratory diseases,but the causal relationship needs to be further interpreted.As there are patients who still have no or little response to surgical therapy,the issue of precise selection of patient before operation still requires further in-depth research.