声带白斑临床病理特征与咽喉反流的初步观察  

Observation of clinicopathological characteristics of vocal fold leukoplakia and laryngopharyngeal reflux

作　　者：朱虹[1] 徐文[1] 李赟[1] 程丽宇 

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 教育部耳鼻咽喉头颈科学重点实验室 首都医科大学,100730

出　　处：《中华耳鼻咽喉头颈外科杂志》2014年第5期368-373,共6页Chinese Journal of Otorhinolaryngology Head and Neck Surgery

摘　　要：目的：探讨声带白斑临床病理特征与咽喉反流特征。方法2011年1月至2013年12月全身麻醉支撑喉镜下行喉显微手术的138例声带白斑患者，分析其临床及病理组织学特征，根据反流症状指数（Reflux symptom index，RSI）量表和反流体征评分（Reflux finding score，RFS）量表分析其咽喉反流特征。结果男性129例，女性9例；平均（x珋＆#177;s）年龄（53.4＆#177;11.5）岁。138例患者病理诊断黏膜慢性炎症或鳞状上皮单纯增生85例（61.6％）；轻度异型18例（13.0％），中度异型10例（7.2％），重度异型增生或原位癌15例（10.9％）；浸润癌10例（7.2％）。重度异型增生或原位癌组及浸润癌组平均年龄明显高于黏膜为炎症或单纯增生患者组，差异有统计学意义（ F＝6.773，P＜0.05）。黏膜炎症或单纯增生的声带黏膜波68.5％正常或接近正常，中、重度以上异型增生的声带黏膜波72.7％～80.0％明显减低。声带白斑病理类型与黏膜波振动程度有相关趋势（秩相关系数r＝0.427，P＜0.001）。 RSI评估阳性30例（21.7％），RFS评估阳性60例（43.5％），以RSI ＞13分或RFS＞7分为反流可疑阳性，共75例（54.3％）。不同病理分型RSI和RFS阳性率差异无统计学意义（χ2值分别为3.537和7.619，P值均＞0.05）。 RSI评估以声嘶（94.9％）、持续清嗓（68.8％）、咽部异物感（62.3％）为最常见症状；RFS量表评估以后连合增生（79.7％）、喉内黏液附着（77.5％）、声带水肿（70.3％）为最常见体征。结论声带白斑病理分型呈现良性、异型及恶性等多样性，黏膜波振动程度与声带白斑病理类型有相关趋势。经反流症状和体征量表评估，约半数以上的声带白斑患者有咽喉反流，不同病理分型间反流发生率没有发现明显区别。Objective To investigate the correlation between clinicopathological characteristics of vocal fold leukoplakia and laryngopharyngeal reflux （ LRP ）.Methods One hundred and thirty-eight patients with vocal leukoplakia who received laryngeal microsurgeries under suspension laryngoscope were recruited in this study.Reflux symptom index （ RSI） and reflux finding score （ RFS） were measured.The clinical features , pathological characteristics were collected.Results There were 129 males and 9 females with a mean age of （ 53.4 ＆#177;11.5 ） years.The mean age of patients with severe dysplasia/carcinoma and invasive carcinoma was significantly older than that of inflammation /hyperplasia（F=6.773,P＆lt;0.05）.In 138 patients, 85 patients （61.6%） were pathologically diagnosed as chronic inflammation or squamous epithelium hyperplasia , 18 patients （ 13.0%） as mild dysplasia , 10 patients （ 7.2%） as moderate dysplasia, 15 patients （10.9%） as severe dysplasia/carcinoma in situ and 10 patients （7.2%） as invasive carcinoma.One hundred and twenty-nine patients （93.5%） complained of hoarseness with clinical courses between 7 days and 20 years.68.5% vocal folds with inflammation/hyperplasia showed nearly normal mucosal waves , and 72.7% to 80.0% vocal folds with moderate or more severe dysplasia showed severe reduced mucosal waves.A correlation existed between the severity of pathological type and the decreased extent of mucosal waves （ rank correlation coefficient was 0.427, P ＆lt;0.001 ）.The prevalence of LPR＆amp;nbsp;diagnosed with RSI ＆gt;13 or RFS＆gt;7 was 54.3%, while the positive rate of RSI was 21.7%and that of RFS was 43.5%.There was no significant differences of the positive rates of RSI and RFS among different pathological types （χ2 values 3.537 and 7.619 respectively with both P ＆gt;0.05 ）.According to RSI evaluation, the most common reflux symptoms were hoarseness （94.9%）, throat clearing （68.8%） and globus sensation （ 62.3%）.The most common R

关 键 词：白斑 声带 咽喉反流 癌前状态 喉肿瘤 癌 鳞状细胞 

分 类 号：R767[医药卫生—耳鼻咽喉科]