小儿声带结节的处理

Management of Vocal Nodule in Chlidren

慢性声嘶是小儿声带病变中最常见的症状，国外报道其发生率为２％～２３．４％，原因多是声带小结。报道慢性声嘶２７９例，多数患儿病程１０个月以上，其中２６９例为声带小结。其它病因包括乳突状瘤，声带麻痹，表皮样囊肿和喉室囊肿等。对声带小结的处理尚有争论，如保守疗法或选择性摘除。作者倾向于手术治疗，并认为：（１）药物治疗声嘶效果不佳；（２）患儿常受到嘲弄；（３）声嘶影响患儿日常活动和生活质量。本文报道疗效良好的有９０％，７％好转。有关解剖知识、麻醉、手术技巧以及手术显微镜的应用对提高疗效有很重要作用。总之小儿声带小结的选择性外科治疗是小儿慢性声嘶处理中的可行方法。

Chronic hoarseness is the most common vocal problem in children.Overseas statistical report state that its incidence is between 2%～23.4% and its primary cause is vocal nodule.Among the 279 children with chronic hoarseness,most of them with a history longer than ten months,treated in this department,269 were found to have vocal nodule.Other cases include papilloma,paralysis of vocal cords,hemoangioma,epidermoid cyst and laryngeal saccule cyst.Management of vocal nodule has been contraversial as weather conservative procedures or selective resection should be the choice.The authors adopted the latter and proposed the following as the indications:(1) hoarseness unresponsive to medical treatment;(2)hoarseness causing mocking;(3)hoarseness influencing the person's daily performance and life quality.The results of our treatment were excellent in 90% of the cases,good in 7%.Improvement of knowledge of the anatomy,anesthesia and procedure techniques and application of surgical microscope are believed to have contributed to the satisfactory results.In conclusion,selective surgical treatment of children's vocal nodule should be considered feasible management option for chronic hoarseness.