声带黏膜白色病变诊断及治疗回顾性研究

A retrospective study on the diagnosis and treatment of vocal folds white lesions

目的分析声带黏膜白色病变的临床表现及诊断，探讨治疗原则。方法回顾性分析2006年1月至2013年12月资料完整的156例患者，喉镜下检查表现为双侧声带黏膜白色改变，男135例，女21例；年龄18～60岁，平均（38．8±8．1）岁。全部患者均有嗓音滥用史，嗓音障碍以中、重度为主。给予发声休息及对症治疗，治疗1个月并追踪观察3个月以上。结果患者于治疗1个月后复查，81例（51．9％）声带黏膜白色病变消退，嗓音恢复正常；71例（45．5％）声带黏膜白色病变范围缩小，嗓音障碍程度减轻；4例（2．6％）声带病变范嗣无明显变化。对4例病变无变化的患者行声带病变活检，其中2例病理结果为声带中-重度不典型增生，给予手术治疗。2个月后复查26例男性仍存在有不同程度的声带黏膜白色改变，3个月后仅7例男性声带黏膜仍有小范同的白色病变。结论声带黏膜白色病变并非全部是病理组织学意义上的癌前病变，不应对所有患者采用手术治疗。

Objective To analyze the pathogenesis and clinical features of the vocal fold white lesions, and to investigate the principles of the diagnosis and treatment. Methods One hundred and fifty- six cases of vocal fold white lesions encountered between Janual7 2006 and December 2013 were analyzed. All patients had bilateral-vocal folds whitening under laryngoseopic examination, and all the patients had been observed over three months. There were 135 males and 21 females in the study, the age ranged from 18 to 60 years, with the mean age of （38.8 ± 8.1 ） years old. All patients had a history of vocal abuse, with moderate-severe degree of voice disorder. Results After a month of voice rest and suitable treatment, the result of reexamination showed that the symptoms faded away in 81 cases （51. 9% ）, with the voice recuperated; the range of white lesion was reduced with the voice improving in 71 cases （45.4%）; the range of white lesion was not obviously changed in 4 cases （2.6%） , the pathological examination in these 4 cases showed moderate-severe dysplasia in two cases, and the surgical treatment was applied for them. Two months later, the reexamination showed 26 male cases still had vocal fold white lesion with various degree; and three months later, only 7 male cases retained mild voeal fold white lesion. Conclusion Histopathologically, not all vocal fold white lesions were laryngeal precancerous lesions, and not all of these patients should be treated surgically.