声带粘膜白色病变的临床特征及预后

A Retrospective Study on the Clinical Analysis and Prognosis with White Lesion of Vocal Cord

臧艳姿;台勇;李靖;万保罗;史保轩;王广科;

1:河南省人民医院

2:郑州大学人民医院

3:河南大学人民医院耳鼻喉科

摘要
目的探讨声带粘膜白色病变的临床病理特征及影响其治疗预后的相关因素。方法以2009年10月至2015年2月诊治的98例声带粘膜白色病变患者为研究对象,其中男80例,女18例;平均年龄47.35±9.54岁,有长期吸烟史者58例(占59.18%),有长期饮酒史者35例(占35.71%),术前常规行窄带成像(narrow band imaging,NBI)内镜检查以及咽喉反流体征评分量表(reflux finding score,RFS)、反流症状指数量表(reflux symptem index,RSI)评估;患者均于全身麻醉下行显微支撑喉镜下声带粘膜白色病变切除术,术后切除的病变组织送病理检查。结果 98例声带粘膜白色病变患者中,RSI>13和/或RFS>7者18例(占18.37%);术后病理诊断分别为粘膜慢性炎症12例(12.24%),鳞状上皮增生13例(13.27%),粘膜轻度异型增生29例(29.59%),中度异型增生32例(32.65%),重度异型增生8例(8.16%),原位癌3例(3.06%),浸润癌1例(1.02%)。98例患者术后随访3~40个月,共12例复发(12.24%),7例癌变(7.14%),其中,12例粘膜慢性炎症者术后无复发,鳞状上皮增生患者中1例(7.69%)复发,无癌变病例;轻度异型增生4例(13.79%)复发,1例癌变(3.44%);中度异型增生患者中5例(15.62%)复发,4例(12.50%)癌变;重度异型增生患者中2例(25.00%)复发,其中2例(25.00%)癌变。本组无死亡病例。结论声带粘膜白色病变的治疗应结合体征及NBI内镜、病理诊断等制定个体化治疗方案,病理诊断类型是声带粘膜白色病变预后的重要指标,病变虽以良性居多,但应密切随访。
关键词
声带;白斑;临床特征;回顾性研究
基金项目(Foundation):
河南省卫计委科技攻关项目(NO.201702196)
作者
臧艳姿;台勇;李靖;万保罗;史保轩;王广科;
参考文献

1 任佳,杨慧,吕丹,等.声带黏膜白色病变154例病理表现及预后分析[J].中华耳鼻咽喉头颈外科杂志,2017,52:381.

2 张红凯,刘红刚.喉癌前病变的分类及其临床病理学研究现状[J].中华病理学杂志,2010,39:570.

3 Ni XG,He S,Xu ZG,et al.Endoscopic diagnosis of laryngeal cancer and precancerous lesions by narrow band imaging[J].Journal of Laryngology&Otology,2011,125:288.

4 黄志刚,韩德民.CO2激光手术治疗声门型喉癌疗效分析[J].中华耳鼻咽喉科杂志,2002,37:219.

5 Barnes L,Eveson JW,Reichard P,et a1.Pathology and genetics of head and neck tumours.WHO classification of tumours[M].Lyon:IARCS Press,2005.177~180.

6 Byeon H.Relationships among smoking,organic,and functional voice disorders in Korean general population[J].J Voice,2015,29:312.

7 周健,陶磊,张铎,等.白细胞介素10启动子单核苷酸多态性与声带白斑易感性研究[J].中华耳鼻咽喉头颈外科杂志,2013,48:1017.

8 Gale N,Michaels L,Luzar B,et al.Current review on squamous intraepithelial lesions of the larynx[J].Histopathology,2009,54:639.

9 Rafii B,Taliercio S,Achlatis S,et al.Incidence of underlying laryngeal pathology in patients initially diagnosed with laryngopharyngeal reflux[J].Laryngoscope,2014,124:1420.

10 庄佩耘,周莉,郝玲,等.反流性喉炎与声带白斑关系的初步探讨[J].听力学及言语疾病杂志,2010,18.448.

11 李进让.咽喉反流性疾病规范化诊断和治疗[J].中国耳鼻咽喉头颈外科,2015,22:435.

12 邱新峰,张珂,王丽.不典型喉黏膜增生性病变临床及病理分析[J].中国耳鼻咽喉头颈外科,2013,20:447.

13 Piazza C,Cocco D,De Benedetto L.et al.Narrow band imaging and high definition television in the assessment of laryngeal Cancer:a prospective study on 279 patients[J].Eur Arch Otorhinolaryngol,2010,267:409.

14 王俊国,沈晓辉,钱晓云,等.声带白斑的CO2激光微创治疗[J].听力学及言语疾病杂志,2010,18:493.

15 Mehanna H,Paleri V,Robson A,et al.Consensus statement by otorhinolaryngologist and pathologists on the diagnosis and management of laryngeal dysplasia[J].Clin Otolaryngol,2010,35:170.

16 Zeitels SM.Premalignant epithelium and microinvasive cancer of the vocalfold:the evolution of phonomircrosurgical management[J],Laryngoscope,1995,105(3 Pt 2):1.

17 Weller MD,Nankivell PC,Mcconkey C,et al.The risk and interval to malignancy of patients with laryngeal dysplasia;a systematic review of case series and meta-analysis[J].Clic Otolaryngol,2010,35:364.

18 许咪咪,张思毅,黄红明.声带白斑82例临床病理特征及预后分析[J].临床耳鼻咽喉头颈外科杂志,2014,28:1394.