声带小结保守治疗的疗效观察

Curative effect of conservative treatment of vocal nodules

目的探讨声带小结的病因,发生发展及治疗。治疗组采用保守治疗的疗效分析,对照组采用纤维电子喉镜下声带小结切除术。分析2组的临床疗效,为临床声带小结的治疗提供一定的依据。方法选择蚌埠市第三人民医院耳鼻喉科2014年1月-2018年1月,4年来门诊声带小结的患者63例,对照组60例为门诊局麻下纤维电子喉镜下声带小结切除的患者,2组患者年龄组、性别以及伴随疾病无临床差别,筛选出不伴有急性喉炎、会厌囊肿、声带任克氏水肿的患者。结果治疗组采用少言语、避免大声用声、雾化吸入及中成药的保守治疗。有效的患者12个月后复查行纤维电子喉镜示声带小结消失,声带前1/3黏膜稍增厚。对照组行声带小结纤维喉镜下切除术,有效的患者术后12个月复查未见新生物复发,声带前1/3有少许白色瘢痕形成。2组有效率和复发率比较差异无统计学意义(均P>0.05),而2组临床伴随症状比较,差异有统计学意义(P<0.05)。结论声带小结保守治疗和纤维喉镜下声带小结切除术,在术后嗓音学改变、肿物的消失、临床症状的改变无明显变化,故声带小结手术一定要严格掌握手术适应证及禁忌证,避免手术的泛滥化。

Objective To explore the etiology, development and treatment of vocal nodules, and provide a basis for the treatment of vocal nodules. Methods Total 63 patients with vocal nodules in the Department of Otolaryngology, the Third People’s Hospital of Bengbu from January 2014 to January 2018 were selected as treatment group. The control group consisted of 60 patients with vocal nodules excised under fibro laryngoscopic under local anesthesia. All patients did not have acute laryngitis, epiglottic cyst and Renke’s edema of vocal cord. There was no clinical difference between the two groups in age, sex and accompanying diseases. Results The treatment group received conservative treatment with less speech, avoiding loud voice, inhalation and Chinese patent medicine. After 12 months, the vocal nodules disappeared and the first third mucosa became slightly thicker. The control group underwent fibro laryngoscopic excision of vocal nodules. No new biological recurrence was found after 12 months’ follow-up. A little white scar was found in the first third of the vocal cords. There was no significant difference in the effective rate and recurrence rate between the two groups(all P>0.05). The clinical concomitant symptoms of the two groups were statistically different(P<0.05). Conclusion There is no statistical significance in the changes of voice, the disappearance of tumor and the changes of clinical symptoms after vocal nodule conservative treatment and fibro laryngoscope excision. Therefore, the indications and contraindications of vocal nodule operation must be strictly controlled to avoid the flooding of operation.