Larenks kanserli hastalarda larengofarengeal reflü prevalansı ve tedavisinin cerrahi tedavi üzerine etkileri

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Tezin Türü: Tıpta Uzmanlık

Tezin Yürütüldüğü Kurum: Ankara Üniversitesi, Tıp Fakültesi, KULAK BURUN BOĞAZ ANABİLİM DALI, Türkiye

Tezin Onay Tarihi: 2002

Tezin Dili: Türkçe

Öğrenci: SAMET ÖZLÜGEDİK

Danışman: İRFAN YORULMAZ

Özet:

ABSTRACT Key words: Laryngopharyngeal reflux, laryngeal cancer, anti-reflux therapy, complication OBJECTIVES: Laryngopharyngeal reflux (LPR) is believed to be an important contributing factor in the etiology of many inflammatory and neoplastic laryngopharyngeal disorders. in this prospective study, we attempted to determine prevalence of the LPR in patients with laryngeal cancer and effects of the anti-reflux therapy on surgical outcome. METHODS: Thirty-one consecutive patients with laryngeal cancer were entered in the study. Ali patients undenvent a 24-hour double-channel ambulatory esophageal pH monitoring study. The prevalence of abnormal acid reflux at the upper and lower esophageal segments were evaluated. Ali LPR-positive patients were started on an anti-reflux regimen postoperatively, either with intravenous ranitidine, oral omeprazole ör lansoprazole. Effects of the anti-reflux therapy on surgical outcome were evaluated. LPR parameters were compared between patients with laryngeal cancer and a control group consisted of retrospectively studied 22 LPR-positive patients with posterior laryngitis. RESULTS: LPR occurred in 19 of 31 (61.3%) patients with laryngeal cancer. Fourteen (45.2%) patients had signifıcant gastroesophageal reflux at the distal esophageal segment. The LPR parameters showed no significant differences between patients with laryngeal carcinoma and control group. None of the patients with laryngeal cancer has a complication of pharyngocutaneus fıstula after total laryngectomy. There were no differences in swallowing time and decanulation time between LPR-negative and LPR-positive patients who undenvent partial laryngectomy. CONCLUSION: Smoking and alcohol are the majör risk factors for laryngeal carcinoma. LPR may act as a co-carcinogen in smokers and drinkers. LPR in the postoperative period may predispose to pharyngocutaneus fıstula formation. Anti-reflux therapy in this period may decrease the risk of this complication. Anti-reflux therapy may decrease swallowing and decanulation time after partial laryngectomy in LPR-positive patients.