喉白斑263例临床病例分析  

Clinical analyses of 263 patients with laryngeal leukoplakia

作　　者：牛燕燕[1] 王剑[1] 霍红[1] 金晓峰[1] 李五一[1] 高志强[1] Niu Yanyan;Wang Jian;Huo Hong;Jin Xiaofeng;Li Wuyi;Gao Zhiqiang(Department of Otorhinolaryngology,Peking Union Medical College Hospital,Chinese Academy of Medical Sciences ＆ Peking Union Medical College,Beijing 100730,China)

机构地区：[1]中国医学科学院北京协和医学院北京协和医院耳鼻咽喉科,100730

出　　处：《中华耳鼻咽喉头颈外科杂志》2018年第8期575-580,共6页Chinese Journal of Otorhinolaryngology Head and Neck Surgery

摘　　要：目的 探讨喉白斑的病因、临床特点、病理特征及复发癌变的相关影响因素.方法 回顾性分析2000年1月至2015年12月北京协和医院耳鼻咽喉科经手术治疗的263例喉白斑患者的临床资料.综合分析病因、临床病理特征、诊治经过与其复发、癌变的相关性.结果 263例喉白斑患者中,病理诊断为鳞状上皮单纯增生143例（54.4％）,轻度异型增生47例（17.9％）,中度异型增生32例（12.2％）,重度异型增生/原位癌33例（12.5％）,浸润癌8例（3.0％）.不同病理分型中,年龄的差异有统计学意义（Kruskal-Wallis秩和检验P＜0.05）,病变范围是否累及双侧声带亦有统计学意义（P＜0.05）.性别、吸烟程度及饮酒程度与病理分型无相关性（P值均＞ 0.05）.随访215例患者中,非癌患者209例,复发率20.6％（43/209）,癌变率5.3％（11/209）.多因素分析表明中、重度异型增生/原位癌的病理分型是影响喉白斑复发和癌变的独立危险因素（P＜0.05）.重度异型增生/原位癌的患者选择保守治疗或显微镜/内镜下声带（部分）切除术或放射治疗,其复发比例分别为8/10、0/10、2/11.结论 喉白斑好发于长期吸烟的中老年男性,病理诊断差异较大.喉白斑的复发和癌变与其病理分型相关,中度及重度异型增生/原位癌者复发及癌变的风险高.对于中度及重度异型增生/原位癌的患者,应积极手术治疗并密切随访.Objective To investigate the etiology,clinical and pathological characteristics of laryngeal leukoplakia and the predictive risk factors of recurrence and malignant transformation.Methods Clinical data of 263 patients with laryngeal leukoplakia between January 2000 and December 2015 were analyzed retrospectively.Results The pathological diagnoses included squamous epithelial hyperplasia （54.4%）,mild dysplasia （17.9%）,moderate dysplasia （12.2%）,severe dysplasia and carcinoma in situ （12.5%）,and invasive carcinoma （3.0%）.Age and the extent of lesion were statistically different among different pathological groups （P 〈 0.05）.Gender,smoking and alcohol consumption did not show statistical differences among different pathological groups （P 〉 0.05）.Follow-up of 215 patients,excluding 6 cases of invasive carcinoma.The recurrence rate was 20.6% （43/209）,and the malignant transformation rate was 5.3% （11/209）.Multivariate analysis showed that pathological classification of moderate to severe dysplasia was the independent risk factor for recurrence and malignant transformation of laryngeal leukoplakia （P 〈 0.05）.In patients with severe dysplasia and carcinoma in situ,the recurrence proportion of conservative treatment,vocal cords （partial） resection and radiotherapy were 8/10,0/10 and 2/11 respectively.Conclusions Laryngeal leukoplakia occurs frequently in elderly men with long-term smoking history.Pathological diagnoses are different.The grade of dysplasia is the predictive risk factor for the recurrence and malignant transformation of laryngeal leukoplakia.More aggressive treatment and closer follow-up should be warranted for patients with moderate dysplasia,severe dysplasia and carcinoma in situ.

关 键 词：白斑 病理学 危险因素 预后 

分 类 号：R767[医药卫生—耳鼻咽喉科]