咽喉反流对 CO2激光声带切除术后创伤性肉芽肿影响的初步观察  

Clinical observation of traumatic granuloma after CO2 laser cordectomy and laryngopharyngeal reflux

作　　者：王丽萍[1] 孙士上[1] 王思宁[1] 梁大帅 季文樾[1] 

机构地区：[1]中国医科大学附属盛京医院耳鼻咽喉科, 沈阳110004

出　　处：《中华耳鼻咽喉头颈外科杂志》2014年第5期374-378,共5页Chinese Journal of Otorhinolaryngology Head and Neck Surgery

基　　金：辽宁省自然基金（20092135）;辽宁省教育厅高校科技研究项目（2009A757）

摘　　要：目的：通过对支撑喉镜下CO2激光声带切除术后肉芽肿的临床观察，探讨咽喉反流因素对创伤性肉芽肿的影响。方法对111例按内镜下声带切除术中切除深度和范围的分类方法分为5组，观察各组术后肉芽肿的发生率。将其中病例数最多的49例Ⅲ型声带切除术，按是否咽喉反流和术后质子泵抑制剂（ proton pump inhibito ，PPI）干预性治疗与否分为4组观察。结果111例接受CO2激光声带切除术的患者，术后56例（50.5％）出现肉芽肿，Ⅰ、Ⅱ、Ⅲ、Ⅳ、Ⅴ型术后创伤性肉芽肿出现率分别为10.0％（1/10）、26.1％（6/23）、53.1％（26/49）、78.6％（11/14）和80.0％（12/15）。5种手术分型与术后肉芽肿发生率的趋势卡方检验有统计学意义（χ2＝20.32，P＜0.01），Spearman秩相关分析显示手术分型与肉芽肿发生率呈正相关趋势（ r＝0.44，P＜0.01）。49例Ⅲ型声带切除术中，分别根据咽喉反流阴性和阳性、使用和未用PPI治疗的4组患者肉芽肿发生率差异有统计学意义（χ2＝5.83，P＜0.05）。咽喉反流阴性使用PPI组术后肉芽肿发生率最低（30.0％），咽喉反流阳性不使用PPI组术后肉芽肿发生率最高（80.0％），差异有统计学意义（χ2＝6.25，P＜0.05）。结论 CO2激光声带切除术的切除深度增加，范围扩大使创伤性肉芽肿的发生率有升高趋势。咽喉反流与PPI治疗对创伤性肉芽肿的发生率有一定影响。Objective Through clinical observation of granuloma after CO 2 laser cordectomy under suspensive laryngoscope to discuss the effects of laryngopharyngeal reflux （ LPR ） to traumatic granuloma . Methods According to the classification of depth and range of CO 2 laser cordectomy , 111 cases were divided into 5 groups , and the incidence of postoperative granuloma of each group was observed .The largest number of the 5 groups was 49 cases of type Ⅲ CO2 laser cordectomy which was subdivided into 4 groups according to whether or not laryngopharyngeal reflux and whether or not proton pump inhibitor （ PPI ） treatment.Results In 111 cases, 56 cases （50.5%） developed granuloma after CO2 laser cordectomy. The incidence of traumatic granuloma after surgery was 10%（1/10）, 26.1%（6/23）, 53.1%（26/49）, 78.6% （11/14）, 80.0% （12/15） in Ⅰ, Ⅱ, Ⅲ, Ⅳ, Ⅴ type, respectively.It had statistical significance in chi-square test between 5 kinds of operative classification and the incidences of postoperative granuloma （χ2 =20.32,P＆lt;0.01） and Spearman correlation analysis showed positive correlation between classification of operation and incidences of granuloma （r=0.44,P＆lt;0.01）.According to LPR （-）, LPR （＋） and PPI （ ＋） , PPI （ -） , the incidence of granuloma had statistical significance in these 4 group patients of 49 typeⅢcases （χ2 =5.83,P＆lt;0.05）.The incidence of granuloma after surgery was the lowest in LPR （ -） PPI （ ＋） group （ 30%） and the highest in LPR （ ＋） PPI （ -） group （ 80%） , and it showed significant difference （χ2 =6.25, P＆lt;0.05）.Conclusions With the increase of removal depth and the range after CO 2 laser cordectomy , it appears rising trend in incidence of granuloma . Laryngopharyngeal reflux and PPI therapy on the incidence of traumatic granuloma has certain influence .

关 键 词：声带 激光疗法 肉芽肿 喉 咽喉反流 

分 类 号：R767.91[医药卫生—耳鼻咽喉科]