声带良性病变显微手术后复发的相关因素分析

Risk factors for recurrence of benign vocal cord lesions after microsurgery

目的分析声带良性病变显微手术后复发的相关因素。方法收集2013年4月至2022年4月在扬州大学附属医院耳鼻咽喉头颈外科接受显微外科手术治疗的声带良性病变患者2214例的临床资料,记录患者的性别、年龄、饮酒史、吸烟史、单双侧病变、诊断等情况,根据入院诊断将2214例患者分为六组:息肉组、Reinke水肿组、白斑组、肉芽肿组、囊肿组和其他良性病变组,随访0~115个月,中位随访时间为55个月。采用Kaplan-Meier曲线分析各组患者在手术治疗后复发率的差异;采用Cox回归模型分析与手术复发相关的风险因素。结果2214例患者中,息肉组1953例(88.21%),肉芽肿组41例(1.85%),囊肿组67例(3.03%),白斑组87例(3.93%),Reinke水肿组34例(1.54%),其他良性病变组32例(1.45%)。复发率:息肉组4.86%(95/1953),肉芽肿组31.70%(13/41),白斑组14.94%(13/87),囊肿组2.98%(2/67),Reinke水肿组8.82%(3/34),其他良性病变组9.37%(3/32)。单因素分析显示,双侧病变(95%CI 6.899~17.289,P<0.001)、吸烟(95%CI 1.282~2.564,P=0.001)、饮酒(95%CI 1.173~2.346,P=0.001)等因素与复发显著相关;白斑(95%CI 1.375~27.011,P=0.017)、肉芽肿(95%CI 3.053~60.980,P=0.001)与囊肿相比,术后的复发率更高。患者术后复发风险的多因素分析显示,双侧病变(95%CI 6.680~16.900,P<0.001)、吸烟(95%CI 1.572~16.157,P=0.007)术后复发风险更高。肉芽肿与术后复发显著相关(95%CI 4.691~97.667,P<0.05)。结论双侧病变、吸烟是声带良性病变显微手术后复发的独立危险因素,肉芽肿与术后复发显著相关。

Objective To investigate the risk factors for recurrence of benign vocal cord lesions after microsurgery.Methods The clinical data of 2214 patients with benign vocal cord lesions who underwent laryngeal microsurgery at the Department of Otolaryngology-Head and Neck Surgery,Affiliated Hospital of Yangzhou University from April 2013 to April 2022 were collected.The data,including sex,age,drinking history,smoking history,unilateral and bilateral lesions,and diagnosis,were recorded.These patients were divided into six groups according to admission diagnosis:polyps,Reinke's edema,leukoplakia,granulomas,cysts,and other benign lesions.All patients were followed up for 0-115 months,with a median follow-up time of 55 months.The Kaplan-Meier curve was used to determine whether there was any difference in the recurrence rate of benign vocal cord lesions among groups after surgical treatment.The Cox regression model was used to analyze the risk factors for the recurrence of benign vocal cord lesions after surgical treatment.Results Out of the 2214 patients,there were 1953 cases of polyps(88.21%),41 cases of granulomas(1.85%),67 cases of cysts(3.03%),87 cases of leukoplakia(3.93%),34 cases of Reinke's edema(1.54%),and 32 cases of other benign lesions(1.45%).The recurrence rate for benign vocal cord lesions was 4.86%(95/1953)in the polyp group,31.70%(13/41)in the granuloma group,14.94%(13/87)in the leukoplakia group,2.98%(2/67)in the cysts group,8.82%(3/34)in the Reinke's edema group,and 9.37%(3/32)in the other benign lesions group.Univariate analysis showed that bilateral lesions(95%CI 6.899-17.289,P<0.001),smoking history(95%CI 1.282-2.564,P=0.001),and alcohol consumption(95%CI 1.173-2.346,P=0.001)were significantly associated with the recurrence of benign vocal cord lesions.The recurrence rate for benign vocal cord lesions in the leukoplakia group(95%CI 1.375-27.011,P=0.017)and granuloma group(95%CI 3.053-60.980,P=0.001)was significantly higher than that in the cysts group.Multivariate analysis of the risk factors for postoperative recurrence of benign vocal cord lesions showed that patients who had bilateral lesions(95%CI 6.680-16.900,P<0.001)and a history of smoking(95%CI 1.572-16.157,P=0.007)had a higher risk of recurrence of benign vocal cord lesions compared with those without bilateral lesions and a history of smoking.Granulomas were found to be significantly associated with postoperative recurrence of benign vocal cord lesions(95%CI 4.691-97.667,P<0.05).Conclusion Bilateral lesions and smoking are independent risk factors for the recurrence of benign vocal cord lesions after microsurgery.Granuloma is strongly associated with the postoperative recurrence of benign vocal cord lesions.