摘要
目的 探讨声带白斑发病的危险因素以及临床特点与病理和复发的关系.方法 收集2010年2月至2016年12月在北京大学人民医院耳鼻咽喉头颈外科行手术治疗的声带白斑患者81例与无咽喉症状的患者160例进行病例对照研究.回顾性总结81例患者的临床特点,并对声带白斑发病的危险因素与病理和复发的关系进行分析.结果 病例组反流症状指数（reflux symptom index,RSI）量表、反流体征评分（reflux finding score,RFS）量表、吸烟指数、饮酒指数与对照组差异有统计学意义（Z=-5.35、-4.82、-4.76、-2.44,P值均＜0.05）;用声过度的比例显著高于对照组（x2=11.38,P =0.01）;综合医院焦虑情绪量表评分、综合医院抑郁情绪量表评分与对照组相比较差异无统计学意义（P＞0.05）.42例接受喉咽食管pH监测的患者咽喉反流阳性率42.8％.81例患者术后病理结果：单纯鳞状上皮增生39例（48％）,轻度异型增生18例（22％）,中度异型增生12例（15％）,重度异型增生10例（12％）,原位癌2例（2％）.高危病理类型白斑发病年龄明显高于低危组[（64±6）岁比（52±14）岁,t=-2.73,P＜0.01];高危病理组散在白斑的比例42％（5/12）与低危组（1.4％,1/69）相比差异有统计学意义（x2=23.81,P＜0.01）.高危病理组与低危病理组的咽喉反流阳性率相比差异无统计学意义（P＞0.05）.双侧、散在白斑更容易复发（x2=4.27、12.17,P值均＜0.05）.病理分化程度越差,越容易复发（Mann-Whiteny U秩和检验Z=-2.168,P=0.03）.复发组与非复发组之间咽喉反流阳性率差异无统计学意义（P＞0.05）.结论 咽喉反流、吸烟是声带白斑的发病因素,饮酒、用声过度与白斑发病相关.高龄、散在白斑是声带白斑高危病理类型的相关因素.散在白斑、双侧白斑、初次病理分化程度越重,声带白斑术后越容易复发。
Objective To investigate the pathogenic factors of vocal leukoplakia and its clinical and pathological features.Methods Eighty-one patients with vocal cord leukoplakia who underwent surgery between February 2010 and December 2016 and 160 volunteers without pharyngeal symptoms designed as controls were included in this case control study.The clinicopathological characteristics of 81 patients were summarized and analyzed synthetically.Results There was statistical significance in reflux symptom index （RSI）,reflux finding score （RFS）,smoking index,and drinking index between case group and control group（Z =-5.35,-4.82,-4.76,-2.44,P 〈 0.05）.The voice-using duration per day in case group was significantly longer than that of control group.There was no statistical significance in hospital anxiety and depression scale for anxiety （HADA） scores、hospital anxiety and depression scale for depression （HADD） scores between case group and control group（P 〉 0.05）.In 42 patients who received 24-hour dual probe pH monitoring the prevalence of pathologic LPR was 42.8%.In 81 patients、39 （48%） patients were pathologically diagnosed as squamous cell hyperplasia,18 （22%）patients as mild dysplasia,12 （15%）sides as moderate dysplasia,10 （12%）patients as severe dysplasia and 2 （2%）patients as carcinoma in-situ.The average age of high-risk pathological vocal leukoplakia was significantly higher than that of low-risk leukoplakia（t =-2.73,P 〈 0.01）.The propotion of speckled leukoplakia in high-risk leukoplakia was significantly higher than that of low-risk leukoplakia （x2 =23.81,P 〈 0.01）.There was no statistical significance between high-risk leukoplakia and low-risk leukoplakia in the prevalence of pathologic LPR （P 〉0.05）.The bilateral lesions,speckled leukoplakia were more likely to relapse （x2 =4.27,12.17,P 〈0.05）.The more serious the pathology,the more likely it was to relapse （Z =-2.168,P =0.03）.There was no statistical significance between recurrence group and non-recurrence group in the prevalence of pathologic LPR （P 〉 0.05）.Conclusions LPR,smoke constitute the risk factors of vocal cord leukoplakia.Drinking,voice abuse are related to vocal cord leukoplakia.Senile,speckled leukoplakia are more likely to be malignancy.A speckled leukoplakia,bilateral leukoplakia,severe pathological degree are important factors to predict recurrence.
作者
王文伦
张立红
曹杰
李超凡
王宇光
赵一馨
Wang Wenlun;Zhang Lihong;Cao Jie;Li Chaofan;Wang Yuguang;Zhao Yixin(Department of Otorhinolaryngology Head and Neck Surgery,Peking University People＇ s Hospital,Beijing 100044,China)
出处
《中华耳鼻咽喉头颈外科杂志》
CAS
CSCD
北大核心
2018年第8期581-586,共6页
Chinese Journal of Otorhinolaryngology Head and Neck Surgery
基金
北京市自然科学基金（2108000082）
关键词
声带
白斑
咽喉反流
病理学
发病因素
复发
Vocal cords
Leukoplakia
Laryngopharyngeal reflux
Pathology
Pathogenic factors
Recurrence
