声带A型肉毒素注射治疗难治性喉接触性肉芽肿的疗效分析  

Analysis of the efficacy of vocal cord botulinum toxin injection for refractory laryngeal contact granuloma

作　　者：王嘉森 李进让 潘宇飞 刘志 张纯 王文静 Wang Jiasen;Li Jinrang;Pan Yufei;Liu Zhi;Zhang Chun;Wang Wenjing(Department of Otorhinolaryngology Head and Neck Surgery of the Sixth Medical Center of PLA General Hospital,National Clinical Research Center for Otolaryngologic Diseases,Beijing 100048,China)

机构地区：[1]中国人民解放军总医院第六医学中心耳鼻咽喉头颈外科医学部咽喉嗓音外科,国家耳鼻咽喉疾病临床医学研究中心,北京100048

出　　处：《中华耳鼻咽喉头颈外科杂志》2024年第10期1048-1053,共6页Chinese Journal of Otorhinolaryngology Head and Neck Surgery

摘　　要：目的分析声带A型肉毒素注射治疗难治性喉接触性肉芽肿的治疗效果。方法回顾性分析2021年5月至2023年5月就诊于解放军总医院第六医学中心耳鼻咽喉头颈外科门诊的52例难治性喉接触性肉芽肿患者临床资料,其中男51例,女1例,年龄22~66(48.98±8.87)岁。所有患者在表面麻醉下接受声带A型肉毒素注射治疗,术后随访12个月以上。统计患者治愈率、总有效率、并发症和复发率等数据,应用Logistic回归分析来确定影响疗效的独立危险因素。结果52例难治性喉接触性肉芽肿患者经声带A型肉毒素注射治疗的治愈率为78.8%(41/52)、总有效率(包括治愈、显效和有效)为90.4%(47/52),中位注射次数为1[1,2]次。1次声带A型肉毒素注射治疗后的治愈率为69.2%(36/52),最终41例治愈患者的中位治疗周期为3[3,3]个月。88.5%(46/52)的患者术后出现声嘶,最长者持续3个月,21.2%(11/52)的患者有呛咳、咽痛、憋气等不适,均在3个月内恢复。41例治愈患者中1例失访,第12个月时的复发率为17.5%(7/40)。多因素回归分析发现,年龄、肉芽肿的大小、质子泵抑制剂治疗史、激素注射史、肉芽肿手术切除史、咽喉反流、慢性咳嗽和过度用嗓不是影响治愈和复发的独立危险因素(P值均>0.05)。结论声带A型肉毒素注射是治疗难治性喉接触性肉芽肿的可选方案,具有治愈率高、治疗周期短、注射次数少的优点。ObjectiveTo observe the efficacy of vocal cord botulinum toxin type A injection in the treatment of refractory laryngeal contact granuloma and to analyze the factors affecting the curative effect.MethodsFifty-two patients with refractory laryngeal contact granuloma who received vocal cord botulinum toxin type A injection under topical anesthesia from May 2021 to May 2023 were analyzed retrospectively.Among them,51 were males and 1 was female,aged 22-66(48.98±8.87)years old.All patients were followed up for a minimum of 12 months.Outcome measures in terms of patient cure rate,total effective rate,complications and recurrence rate were calculated.The median[M(Q 1,Q 3)]was used to represent non-normally distributed measurement data,and Logistic regression analysis was used to determine independent risk factors affecting efficacy.ResultsThe cure rate of 52 patients with refractory laryngeal contact granuloma treated by vocal cord botulinum toxin type A injection was 78.8%(41/52),and the total effective rate(including cure,marked and effective)was 90.4%(47/52).The median number of injections was 1[1,2].Following a single injection,the cure rate was 69.2%(36/52),and the median treatment duration for cured patients was 3[3,3]months.Hoarseness occurred in 88.5%(46/52)of patients,with recovery within 3 months in all cases.Additionally,21.2%(11/52)of the patients experienced cough,sore throat,dyspnea,all of whom recovered within 3 months.One patient among the 41 cured cases was lost to follow-up,and the recurrence rate at the 12th month was 17.5%(7/40).Multivariate regression analysis indicated that age,granuloma size,history of PPI treatment,previous corticosteroid injections,prior surgical excision,pharyngeal reflux,chronic cough,pharyngeal reflux,chronic cough and vocal overuse were not independent risk factors for cure and recurrence.ConclusionVocal cord botulinum toxin type A injection is an alternative for the treatment of refractory laryngeal contact granuloma,which offers benefits such ashigh cure rate,short treat

关 键 词：喉接触性肉芽肿 声带注射 肉毒素 甲杓肌 疗效分析 

分 类 号：R767[医药卫生—耳鼻咽喉科]