喉接触性肉芽肿的临床特点  

Clinical characteristics of laryngeal contact granuloma

作　　者：侯丽珍[1] 徐文[1] 韩德民[1,2] 

机构地区：[1]首都医科大学附属北京同仁医院耳鼻咽喉头颈外科耳鼻咽喉头颈科学教育部重点实验室(首都医科大学),北京100730 [2]北京市耳鼻咽喉科研究所,北京100005

出　　处：《中国耳鼻咽喉头颈外科》2009年第9期517-520,共4页Chinese Archives of Otolaryngology-Head and Neck Surgery

摘　　要：目的分析喉接触性肉芽肿的临床特点。方法回顾性分析84例喉接触性肉芽肿患者的病史、症状、临床检查、治疗和预后。结果喉接触性肉芽肿发病以男性多见(72/84,85.7%),其中男性患者多有长期反酸、用声不当、清嗓、咳嗽及吸烟史;女性患者大部分(7/12,58.3%)为插管所致,其次为反酸(4/12,33.3%)。症状以声嘶、发声费力、咽异物感最为多见。病变位于声带突处,单侧病变多发(75/84,89.3%),发音时声门闭合有缝。嗓音主观评估结果为G_1R_1B_0A_0S_0。声学分析频率微扰、振幅微扰、标准化噪声能量均明显高于正常对照组;女性患者较男性症状重,各嗓音学参数明显高于男性。患者甲杓肌肌电波幅/转折数高于正常对照组。42.9%(36/84)患者抗酸、发声休息、发声矫治等保守治疗后病变消失,11.9%(10/84)患者好转,45.2%(38/84)无效患者手术治疗配合保守治疗治愈73.7%(28/38),好转10.5%(4/38),术后复发15.8%(6/38),其中2例复发患者再次手术同时患侧甲杓肌注射肉毒素A治愈。结论喉接触性肉芽肿病因较多,男女发病特点不同,明确诊断后,应根据病因及临床特点,确定个体化治疗方案。OBJECTIVE To summarize the morbility,etiological factor,symptoms,treatment and prognosis of laryngeal contact granuloma. METHODS A retrospective study was carried out among 84 patients with this disease on their clinical characteristics.RESULTS 85.7%patients were male, most of which had a long history of regurgitation,voice abusing,throat clearing,cough or smoking.58.3% female patients had a history of intubation.The most common symptoms were hoarseness,voice fatigue and foreign body sensation in pharynx.Under stroboscopy, the granuloma located in the vocal process,the glottis couldn＇t closed completely during phonation.Subjective voice evaluation result was G_1R_1B_0A_0S_0.Voice acoustic analysis：jitter,shimmer,normalized noise energy （NNE） of patients were statisticly higher than those of normal control.Symptoms of female patients were more serious than those of male.Amplitude/turns of thyroarytenoid muscle in laryngeal electromyography （LEMG） were higher than normal control.42.9% patients were healed after received antireflux therapy, voice therapy and other medical treatments,11.9% patients ＇granulomas obviously smaller than before. Other ineffective patients received surgical excision, 73.7%were healed,10.5%had a smaller granuloma, 6 cases recurrenced,in which 2 cases were healed after another surgical excision and botulinum toxin type A injection.CONCLUSION Laryngeal contact granuloma has many etiological factors,its clinical characteristics have gender differences.Treatment should be individualized according to etiology and clinical feature.

关 键 词：肉芽肿 喉 言语声学 治疗结果 

分 类 号：R767[医药卫生—耳鼻咽喉科]