11例声带真菌感染误诊临床分析  

Clinical Analysis of Misdiagnosis of Fungal Infection of Vocal Cord in 11 Patients

作　　者：文森林 葛士波 周永青 邸斌 宋琦 肖淑芬 李震 李晓明 WEN Senlin;GE Shibo;ZHOU Yongqing;DI Bin;SONG Qi;XIAO Shufen;LI Zhen;LI Xiaoming(Department of Otorhinolaryngology,Head and Neck Surgery,the 980th Hospital of Joint Logistic Support Force of the PLA/Bethune International Peace Hospital,Shijiazhuang 050081,China)

机构地区：[1]解放军联勤保障部队第九八〇医院耳鼻咽喉头颈外科,石家庄050081

出　　处：《临床误诊误治》2024年第20期18-21,共4页Clinical Misdiagnosis & Mistherapy

摘　　要：目的 探讨声带真菌感染的病因、临床特点、误诊原因、诊断与治疗方法。方法 回顾分析2022年6月至2023年12月诊治的11例声带真菌感染患者临床资料。结果 11例均因声音嘶哑就诊,均有上呼吸道感染史、长期抗生素使用史及长期糖皮质激素使用史,外院诊断为声带炎4例、急性喉炎7例,后经电子喉镜检查提示双侧声带急性充血,表面覆盖大片灰白色或灰黄色豆腐渣样膜状物,病理检查均确诊声带真菌感染,误诊时间3~23 d。经休声、停用抗生素及糖皮质激素,并予抗真菌治疗1个月后治愈,随访半年以上均无复发。结论 声带真菌感染多于上呼吸道感染后、滥用抗生素及糖皮质激素后发病,易误诊误治;病理检查是本病诊断金标准,当电子喉镜检查发现双侧声带表面大片伪膜附着、溃疡、肉芽肿时,应及时行病理检查以确诊,全身使用抗真菌药物可治愈。Objective To investigate the etiology,clinical characteristics,causes of misdiagnosis,diagnosis and treatment of fungal infection of vocal cord.Methods The clinical data of 11 patients with fungal infection of vocal cord from June 2022 to December 2023 were retrospectively analyzed.Results All 11 patients presented with hoarseness and had a history of upper respiratory tract infection,long-term antibiotic use and long-term glucocorticoid use.Four patients were diagnosed as vocal cord inflammation and 7 patients as acute laryngitis in other hospitals.Subsequently,electronic laryngoscopy examination showed acute congestion of both vocal cords,with large areas of gray white or gray yellow film like beancurd residue covering the surface.After pathological examination,fungal infection of vocal cord was confirmed,and the duration of misdiagnosis was 3-23 d.After resting the voice,discontinuing antibiotics and corticosteroids,and receiving antifungal treatment for one month,the patient was cured,and there was no recurrence after follow-up for more than 6 months.Conclusion Fungal infection of vocal cord is more common after upper respiratory tract infection and abuse of antibiotics and glucocorticoids,which is prone to misdiagnosis and mistreatment.Pathological examination is the gold standard for the diagnosis of this disease.When electronic laryngoscopy reveals large pseudomembrane attachment,ulceration and granuloma on the surface of bilateral vocal cords,pathological examination should be performed in time to confirm the diagnosis,and systemic antifungal drugs can help cure the disease.

关 键 词：真菌感染 声带 误诊 声带炎 急性喉炎 组织病理检查 

分 类 号：R763[医药卫生—耳鼻咽喉科]