CAJ | 학술논문

目的探讨声带黏膜鳞状上皮病变的临床特征与治疗效果.方法分析343例声带黏膜鳞状上皮病变患者的病史、电子鼻咽喉镜或频闪喉镜及手术显微镜下的形态学特征及病理学结果,探讨声带黏膜鳞状上皮病变的治疗方式、治疗效果与临床特征的相关性.结果根据343例声带黏膜鳞状上皮病变的镜下特征分为4型.Ⅰ型为炎性渗出型,19例,经保守治疗声带形态及声音质量恢复正常.Ⅱ、Ⅲ、Ⅳ型病变均行显微支撑喉镜下CO2激光手术.Ⅱ型为息肉摩擦型,72例,采用声带黏膜上皮下切除术;Ⅲ型为伴声带沟型,64例,采用黏膜切开挖槽术；Ⅳ型为单纯角化型,188例,采用声韧带下切除术或声带肌切除术.手术一次治愈率为90.7％( 294/324),复发率为9.3％(30/324),癌变率6.5％ (21/324).癌变者均为Ⅳ型患者(11.2％),第一次手术诊断8例,二次手术诊断13例,其中2例患者第三次手术采用喉垂直部分切除术.结论根据声带黏膜鳞状上皮病变的形态学特征,采用保守或CO2激光手术,可以最大限度地保留喉功能,减少并发症.
목적 탐토성대점막린상상피병변적림상특정여치료효과.방법 분석343례성대점막린상상피병변환자적병사、전자비인후경혹빈섬후경급수술현미경하적형태학특정급병이학결과,탐토성대점막린상상피병변적치료방식、치료효과여림상특정적상관성.결과 근거343례성대점막린상상피병변적경하특정분위4형.Ⅰ형위염성삼출형,19례,경보수치료성대형태급성음질량회복정상.Ⅱ、Ⅲ、Ⅳ형병변균행현미지탱후경하CO2격광수술.Ⅱ형위식육마찰형,72례,채용성대점막상피하절제술;Ⅲ형위반성대구형,64례,채용점막절개알조술；Ⅳ형위단순각화형,188례,채용성인대하절제술혹성대기절제술.수술일차치유솔위90.7％( 294/324),복발솔위9.3％(30/324),암변솔6.5％ (21/324).암변자균위Ⅳ형환자(11.2％),제일차수술진단8례,이차수술진단13례,기중2례환자제삼차수술채용후수직부분절제술.결론 근거성대점막린상상피병변적형태학특정,채용보수혹CO2격광수술,가이최대한도지보류후공능,감소병발증.
Objective To discuss the clinical classification of the squamous intraepithelial lesions (SILs) of vocal cord and their outcomes after different therapeutic procedures.Methods Three hundred and forty-three patients with the SILs of vocal cord were enrolled.Based on the history of the diseases,macroscopic appearance by video rhinolaryngoscopic,stroboscopic and microlaryngocopic examination,and pathological findings,the correlation of clinical features,treatment modalities and treatment effect of the vocal cord SILs were discussed.Results According to the morphological characteristics,343 patients were divided into four types.Type Ⅰ,leukoplakia combined with inflammation ( n =19 ) ; type Ⅱ,leukoplakia combined with polyps by friction ( n =72 ) ; type Ⅲ,leukoplakia combined with sulcus vocalis ( n =64 ) ;type Ⅳ,keratosis (n =188 ).Patients with type Ⅰ lesions were treated by medications.The vocal cord configuration and the voice of the patients in type Ⅰ returned to normal after treatment.Patients with type Ⅱ,Ⅲ,Ⅳ lesions were treated by CO2 laser.Type Ⅱ were treated by subepithelial cordectomy,type Ⅲ by mucosa slicing with dredging,type Ⅳ by subligament cordectomy or transmuscular cordectomy.The cure rate of patients with type Ⅱ,Ⅲ,Ⅳ lesions was 90.7％ (294/324) after single surgery,the recurrent rate was 9.3％ (30/324).Twenty-one patients( 11.2％ ),all in type Ⅳ,developed carcinogenesis.Eight cases were diagnosed in the first surgery and 13 cases in the second.Among the 13 cases diagnosed in the second surgery,2 cases had partial laryngectomy for the third surgery.Conclusions Since the squamous intraepithelial lesions of vocal cord manifested differently,conservative treatment or CO2 laser surgery should be used.In this way,a less invasive procedure,better recovery of the voice and less complication could be expected.