声带白斑的临床特征及与咽喉反流的关系分析

Clinical characteristics of vocal leukoplakia and its relationship with laryngopharyngeal reflux

目的探讨声带白斑的临床特征及与咽喉反流的关系。方法回顾性分析2020年1月至2021年5月本院收治的100例声带白斑患者的临床资料,采用国际头颈病理学的分类标准分析声带白斑的类型,记录两组声带白斑的临床特征、声带病变黏膜波振动特征及咽喉返流特点。分析不同病理特征的声带病变黏膜波振动特点及临床特征分布情况,比较咽喉反流阳性与咽喉反流阴性患者反流指标、反流症状评分,分析声带白斑与咽喉反流的相关性。结果100例患者频闪喉镜检查过程中发现,有8例检测无意义;无异型63例,占比63.00%;轻度异型11例,占比11.00%;中度异型6例,占比6.00%;重度异型12例,占比12.00%。无异型的黏膜波主要以正常状态为主,占比68.25%,无异型黏膜波正常高于中度异型和重度异型,差异有统计学意义(P<0.05);中度异型主要以黏膜波重度降低为主,占比66.67%,中度异型黏膜波重度降低高于无异型和轻度异型黏膜波重度降低,差异有统计学意义(P<0.05)。无异型中,以声嘶、多次清嗓、连合增生为主要临床特征;轻度异型中,以声嘶、多次清嗓、吞咽异物感为主要临床特征;中度异性中,以声嘶、多次清嗓、连合增生为主要临床特征;重度异型中,以声嘶、多次清嗓、咽喉有异物感、连合增生为主要临床特征。咽喉反流阳性患者最长反流时间、每次反流时间、总反流时间均长于咽喉反流阴性患者,总反流次数、反流百分比均明显高于咽喉反流阴性患者,差异有统计学意义(P<0.05)。咽喉反流阳性患者多次清嗓、发音受阻、吞咽异物感、反酸灼心及总评分均高于咽喉反流阴性患者,差异有统计学意义(P<0.05)。Pearson相关性分析显示,咽喉反流阳性与声带白斑呈正相关(r>0,P<0.05)。结论声带白斑主要病理特征为无异型,主要临床特征为声嘶、多次清嗓,与咽喉反流呈正相关。

Objective To investigate the clinical features of vocal leukoplakia and its relationship with laryngopharyngeal reflux.Methods The clinical data of 100 patients with vocal leukoplakia admitted to our hospital from January 2020 to May 2021 were retrospectively analyzed,the types of vocal leukoplakia were analyzed using the international classification standard of head and neck pathology.Clinical characteristics of vocal leukoplakia,mucosal wave vibration characteristics of vocal lesions and laryngeal reflux characteristics of the two groups of patients were recorded.The distribution of mucosal wave vibration characteristics and clinical characteristics of vocal cord lesions with different pathological characteristics were analyzed,reflux indicators and reflux symptom scores of patients with positive and negative pharyngeal reflux were compared,and the correlation between vocal cord leukopleck and pharyngeal reflux was analyzed.Results In the 100 cases of stroboscopic laryngoscopy,8 cases were found to be nonsensical.Among the 92 cases,63 cases had no atypia,accounting for 63.00%;11 cases had mild atypia,accounting for 11.00%;6 cases had moderate atypia,accounting for 6.00%;12 cases with severe atypia,accounting for 12.00%;the normal condition was the main condition of mucosa waves without atypia,accounting for 68.25%,the normal condition of mucosa waves without atypia was higher than that of moderate atypia and severe atypia,and the difference was statistically significant(P<0.05);moderate atypia mainly decreased the severity of mucosa waves,accounting for 66.67%,and the severity of moderate atypia mucosa waves decreased more than that of no atypia and mild atypia mucosa waves,and the difference was statistically significant(P<0.05).In the patients without atypia,the main clinical features were hoarseness,multiple throat-clearing and conjunctive hyperplasia;in mild atypia,the main clinical features were hoarseness,multiple throat-clearing and foreign body sensation in the throat;in moderate heterosexuals,the main clinical features were hoarseness,multiple throat-clearing and conjunctive hyperplasia;in severe atypia,the main clinical features were hoarseness,multiple throat-clearing,foreign body sensation in the throat,and union hyperplasia.The longest reflux time,each reflux time and total reflux time in positive pharyngopharyngeal reflux patients were all longer than those in negative pharyngopharyngeal reflux patients,and the total reflux time and percentage were significantly higher than those in negative pharyngopharyngeal reflux patients,and the differences were statistically significant(P<0.05).Multiple throat-clearing,obstruction of pronunciation,foreign body sensation in swallowing,acid reflux burning and total score in positive laryngopharyngeal reflux patients were higher than those in negative laryngopharyngeal reflux patients,and the differences were statistically significant(P<0.05).Pearson correlation analysis showed that positive pharyngopharyngeal reflux was positively correlated with vocal leucosis(r>0,P<0.05).Conclusion The main pathological features of vocal leucosis were no atypia,and the main clinical features were hoarseness and multiple throat-clearing,which were positively correlated with pharyngeal reflux.