粒细胞减少症在咽喉部的表现(附35例报告)

Clinical features of granulocytopenia in the pharynx and larynx( with a report of 35 cases)

目的总结粒细胞减少性症在咽喉部的表现,探讨其临床特点,提高耳鼻咽喉科医生对该病的认识。方法对2010~2015年表现为咽喉部症状、首诊于耳鼻咽喉科且最终确诊为粒细胞减少症的35例患者的临床资料进行回顾性分析。结果 35例患者均以不同程度的发热伴咽痛为主诉就诊。咽喉部查体均存在不同程度的黏膜肿胀苍白、淋巴滤泡增生及黏性分泌物增多,以坏死性溃疡为主。初诊为咽部特殊感染10例,急性咽峡炎10例,咽部真菌感染4例,急性喉炎4例,急性化脓性扁桃体炎2例,樊尚咽峡炎2例,急性会厌炎2例,恶性淋巴瘤1例。最终确诊为粒细胞减少症,经内科疗法治愈32例,3例行气管切开,1例术后死亡。结论粒细胞减少症病因复杂,症状无特异性,掌握以咽喉部症状为主要表现的粒细胞减少症的临床特点,对其早诊断、早治疗和预后具有重要的临床意义。

Objective To improve otolaryngology doctors＇ recognition of granulocytopenia via summarizing its manifestations reflected in throat and discussing the clinical characteristics of this disease. Methods Clinical data of 35 patients with throat symptoms visiting Department of Otolaryngology first and uhimately diagnosed as granulocytopenia from 2010 to 2015 were analyzed retrospectively. Results All 35 patients visited our department first with various degrees of fever and sore throat as chief complaints. Pharyngolaryneal examinations showed necrotic ulcer-based features with different degrees of mucosal swelling and pale, hyperplasia of lymphoid follicle and increased sticky secretion. The preliminary diagnosis included special pharyngeal infection （ n = 10 ）, acute angina （ n = 10 ） , fungal infection in pharynx （ n = 4 ）, acute laryngitis （ n = 4 ） , acute suppurative tonsillitis （ n = 2 ） , Vincent＇ s angina （ n = 2 ） , acute epiglottitis （ n = 2 ） , and malignant lymphoma （ n = 1 ）. All the patients were hospitalized and eventually diagnosed with granuloeytopenia. 32 cases were cured by medical therapy, while 3 cases underwent tracheotomy and one died after surgery. Conclusion Due to its complicated etiology and nonspeeific symptoms, grasping the clinical characteristics of granulocytopenia presenting prominently with throat symptoms is of great clinical significance for its early diagnosis, treatment and prognosis.