咽喉部Ⅱ期梅毒21例黏膜损害形态和临床特征分析

The Mucous Morphological and Clinical Characteristics of Stage Ⅱ Laryngeal and Pharyngeal Syphilis

目的探讨咽喉部梅毒的鉴别和诊断要点。方法回顾性分析2011年2月-2015年1月在本院耳鼻咽喉科以咽喉症状及咽喉部黏膜损害为特征首诊的21例Ⅱ期梅毒患者的临床资料,包括纤维喉镜检查结果、皮损部位和形态及临床特征等。结果该21例患者主要病损区域均是以扁桃体和软腭为中心的口咽部,累及舌根者8例,伴喉部黏膜受损者5例。病损黏膜均表现为周围伴有红色充血带的黏膜白斑,未发现单独存在黏膜红斑的病例。喉部黏膜均伴有非特异性炎症,其中4例声嘶患者声带充血和肿胀,黏膜呈白斑样增生。抗梅毒治疗的预后均较好。结论咽喉部Ⅱ期梅毒病损区域多为扁桃体和软腭为中心的口咽部,但常伴有喉炎,并可加重声带的机械性损伤。病损主要为黏膜白斑,白斑周围伴潮红色充血带,结合病损局部检查(病理活检和渗出物涂片)和梅毒血清实验室检查可以确诊,青霉素为该病治疗的一线用药。

Objective To study the identification and diagnosis of laryngeal and pharyngeal syphilis. Methods A total of 21 cases of stage H syphilis patients were collected during 2011-2015 who got initial diagnosis characterized with laryngeal and pharyngeal mueosa damage. All the patients underwent electronic fiber laryngoscope , the morphology of lesions and clinical features were analyzed. Results The lesions of 21 cases are all based on the pharynx with tonsil and soft-palate as the center,include 8 cases involving the tongue root and 5 cases with laryngeal mucosa impaired. The morphology is leukoplakia with a red congestion around. All throat secondary syphilis patients show non-specific inflammation. Four cases with hoarseness got vocal cord congestion and mucosal hyperplasia. The treatment of syphilis had good prognosis. Conclusion The mucosal lesions are mostly at pharynx with tonsil and soft-palate as the center, and often affect laryngeal mucosa, resulting in a non-specific syphilitic laryngitis, that can increase the mechanical damage of the vocal cords. The typical mucosal lesion is leukoplakia with a red congestion around. Pathology and serology examination can confirm a case. Penicillin is the first-line drug in the treatment of this disease.