声带突肉芽肿的发生机制及治疗原则

Study of the Mechanism of Vocal Cord Granulomas and Principles of Treatment

目的通过分析声带突肉芽肿的病因及发生机制,探讨声带突肉芽肿的有效治疗方案。方法对24例确诊的声带突肉芽肿患者的性别、年龄、职业、发生原因(用声情况、咽喉反流、全麻插管)、治疗经过及治疗结果进行分析。结果24例患者中,男22例,女2例;年龄35～71岁(平均48.5岁)。根据引起肉芽肿的原因将患者分为4组:①不良发声行为组9例;②咽喉反流组8例;③全麻插管致病组2例;④无明确原因组5例。治疗方法:9例患者接受外科手术切除,8例术后复发,1例治愈。18例患者进行抗咽喉反流治疗,其中包括8例手术复发患者。治疗时间为3～6个月(平均4.4个月)。11例肉芽肿完全消失,其余7例肉芽肿明显缩小。5例患者未接受任何治疗(3例原因不明者及2例全麻插管后发生者),经过6个月以上的观察,5例患者的肉芽肿消失。结论导致声带突肉芽肿的原因较多,胃酸反流是一个重要的致病因素;手术治疗后复发率高,抗咽喉反流及发声再教育是治疗声带突肉芽肿的主要方法。

Objective The objective of this experiment was to find out the causes and mechanisms of vocal cord granulomas, to analyze the results of different treatments and to establish an effective protocol of treatment. Methods 24 patients with vocal cord granulomas were analyzed in terms of genders, ages, occupations, etiologies, such as voicing, gastroesophageal reflux, and treatment under general anesthesia and jet--ventilation, treatments and outcomes. Results Based on different etiologies, patients were divided into 4 groups; Group I of 9 patients with pathologic phonation, Group Ⅱ of 8 patients with gastroesophageal reflux, Group Ⅲ of 2 patients with treatment under general anesthesia and jet--ventilation, Group Ⅳ of 5 patients with unknown causes. 9 patients received operations while 8 demonstrated good prognosis and one was completely cured. The vocal cord granulomas for 11 patients disappeared, 8 had reduced vocal cord granulomas, and the vocal cord granulomas for 5 patients without any treatment were gone 6 months later. Conclusion The vocal cord granulomas can be caused by many factors with gastroesophageal reflux as a main etiology. Higher recurrences were noted after surgical treatment; therefore, treatment for gastroesophageal reflux and voice therapy should be considered as major approaches.