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首页> 外文期刊>The Laryngoscope: A Medical Journal for Clinical and Research Contributions in Otolaryngology, Head and Neck Medicine and Surgery, Facial Plastic and Reconstructive Surgery .. >The role of Acid and alkaline reflux in laryngeal squamous cell carcinoma.
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The role of Acid and alkaline reflux in laryngeal squamous cell carcinoma.

机译：酸和碱反流在喉鳞状细胞癌中的作用。

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HYPOTHESIS At present, main factors considered responsible for the onset of squamous cell carcinoma are tobacco smoking, alcohol abuse, and exposure to viral and toxic agents. In last years, great interest has been focused on gastroesophageal reflux as independent carcinogenic factor and co-carcinogen in association with smoking and alcohol assumption.STUDY DESIGN Initially, the aim of this study was to objectively evaluate the presence of distal and proximal esophageal reflux with multielectrode pH measurement in patients with cancer of the larynx and/or hypopharynx (group A). However, in the course of the study, pharyngolaryngeal cancer was also observed in 4 patients with achlorhydria; therefore, the hypothesis that alkaline reflux might be involved in the onset of laryngeal cancer was tested (group B).METHODS Twenty-one consecutive patients with laryngeal or hypopharyngolaryngeal squamous cell carcinoma (group A) entered the study. Twenty-one patients without laryngo-pharyngeal diseases were used as control subjects. A validated questionnaire of the clinical history was completed by all patients who underwent 24-hour pH monitoring. Group B included 40 consecutive gastrectomized patients (28 males and 12 females) in whom biliary or alkaline reflux was directly consequent to Billroth I or Billroth II operation. The control group was composed of 40 non-gastrectomized dyspeptic patients. The clinical history was controlled and obtained; EDGS and ENT examination with videolaryngoscopy was performed in all patients.RESULTS In group A, pH measurement showed pathological reflux in 80.9% (17 of 21) of patients with no typical symptoms in 63.7% of them. The difference was significant with respect to the control group. In group B, 6 of 40 (15%) had preneoplastic lesions or a history of laryngeal tumor. The difference was significant with respect to the control group. A total of 7.5% of group B patients had previously undergone CO laser cordectomy for laryngeal squamous cell carcinoma and 7.5% had leukoplakia. We found a significantly higher incidence (<.05) of neoplastic and preneoplastic disease of the larynx in patients undergoing Billroth II and total gastrectomy than in those undergoing Billroth I and Roux-en-Y resection. We also found a significant increase (<.01) in ENT lesions in the group of patients who had undergone gastrectomy more than 20 years previously.(2)CONCLUSIONS In agreement with literature reports, results obtained in group A confirmed that gastroesophageal reflux is often present in patients with neoplastic lesions of the pharynx and larynx. Furthermore, gastric resection is indicated for the first time as an additional risk factor or cofactor of precancerosis and squamous cell carcinoma of the pharynx or larynx. Further studies are necessary to establish the cause and effect relationship between biliary reflux and pharyngo-laryngeal tumors.
机译：假设目前，认为引起鳞状细胞癌发作的主要因素是吸烟，酗酒以及接触病毒和有毒物质。近年来，人们对胃食管反流作为独立的致癌因子和共致癌物与吸烟和饮酒的假设有浓厚的兴趣。研究设计最初，本研究的目的是客观评估食管远端和近端食管反流的存在。喉和/或下咽癌（A组）患者的多电极pH测量。但是，在研究过程中，也有4例胃酸缺乏症患者发现了咽喉癌。因此，检验了碱性返流可能与喉癌发病有关的假说（B组）。方法连续研究21例喉癌或下咽喉鳞状细胞癌（A组）患者。 21例无喉咽疾病的患者被用作对照对象。所有接受24小时pH监测的患者均填写了一份经过验证的临床病史问卷。 B组包括40例连续进行了胃切除术的患者（男28例，女12例），其中Billroth I或Billroth II手术直接导致胆汁或碱性反流。对照组由40名非胃切除术的消化不良患者组成。控制并获得临床病史;结果所有患者均进行了EDGS和耳鼻喉镜检查。结果在A组中，有63.7％无典型症状的患者中有80.9％（21人中有17人）出现病理性反流。相对于对照组而言，差异是显着的。 B组中有40人中有6人（占15％）有肿瘤前病变或有喉癌史。相对于对照组而言，差异是显着的。总共7.5％的B组患者先前曾因喉鳞状细胞癌接受过CO激光脐带切除术，而7.5％的患者有白斑。我们发现，接受Billroth II和全胃切除术的患者的喉癌和肿瘤前疾病的发生率（<.05）明显高于接受Billroth I和Roux-en-Y切除术的患者。我们还发现在20年前接受胃切除术的患者组中ENT病变显着增加（<.01）。（2）结论与文献报道一致，A组获得的结果证实胃食管反流经常发生目前存在于咽部和喉部的肿瘤性病变患者中。此外，首次将胃切除术作为咽癌或喉癌的癌前病变和鳞状细胞癌的附加危险因素或辅助因子。建立胆汁反流与咽喉肿瘤之间的因果关系还需要进一步的研究。

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