| | | | | 频闪喉镜检查对声带白斑激光手术的价值 | | | 倪鑫;马丽晶;王军;王琪 | | | 目的探讨声带白斑手术前频闪喉镜检查与CO2激光手术切除范围及手术治疗效果的相关性。方法1999～2002年72例在我科行CO2激光手术的声带白斑或声带角化患者,手术前进行频闪喉镜检查,观察病变范围及病变侧黏膜波的改变,采用不同的手术切除范围,术后随访3年以上。分析不同组织病理学结果与黏膜波改变之间的差异。结果72例声带白斑患者中,黏膜波正常者24例(33.3%),患侧黏膜波轻度减低者25例(34.7%),中度减低者10例(13.9%),重度减低者13例(18.1%)。术后病理结果,51.4%(37/72)为角化不伴有不典型增生,19.4%(14/72)为角化伴有轻度不典型增生,12.5%(9/72)为角化伴有中度不典型增生,16.7%(12/72)为角化伴有重度不典型增生,其中3例可疑癌变。根据频闪喉镜检查结果采用不同的手术切除范围,72例患者一次治愈率为88.9%(64/72),癌变率为6.94%(5/72)。结论频闪喉镜检查可以作为声带白斑的术前评估手段,结合CO2激光手术对声带白斑进行早期干预治疗,降低癌变率,提高治愈率。
【作者单位】：首都医科大学附属北京同仁医院耳鼻咽喉头颈外科 耳鼻咽喉头颈科学教育部重点实验室(首都医科大学);首都医科大学附属北京同仁医院耳鼻咽喉头颈外科;耳鼻咽喉头颈科学教育部重点实验室(首都医科大学);首都医科大学附属北京同仁医院耳鼻咽喉头颈外科;耳鼻咽喉头颈科学教育部重点实验室(首都医科大学);首都医科大学附属北京同仁医院耳鼻咽喉头颈外科;耳鼻咽喉头颈科学教育部重点实验室(首都医科大学);北京100730;北京100730;北京100730;北京100730
【关键词】：动态镜检查;白斑;声带;激光手术
【分类号】：R767
【DOI】：CNKI:SUN:EBYT.0.2007-12-015
【正文快照】：
喉白斑又称喉黏膜白斑病,是指喉黏膜上皮片状角化增生性病变,多见于声带,由于存在潜在恶变的倾向,一般视为癌前期病变[1]。由于声带白斑包涵了从良性增生到重度不典型增生多种病理变化,不同病变的肉眼表现大致相似,术前临床评估很难与术后病理结果完全符合,因此如何在治疗过度 | | |  推荐 CAJ下载  PDF下载 | | | CAJViewer7.0阅读器支持所有CNKI文件格式，AdobeReader仅支持PDF格式 | | | | Value of laryngostroboscope in assessment of the efficacy of vocal leukoplakia with CO_2 laser surgery | | | NI Xin;MA Lijing;WANG Jun;WANG Qi (Department of Otolaryngology Head and Neck Surgery;Beijing Tongren Hospital;Capital Medical University;Key Laboratory of Otolaryngology Head and Neck Surgery (Capital Medical University);Ministery of Education;Beijing;100730;China)[ | | | OBJECTIVE To explore the relation between preoperative stroboscopic observation of vocal leukoplakia and the excision extension of CO2 laser surgery. METHODS The clinical data of 72 patients who underwent endoscopic CO2 laser surgery for excision of vocal leukoplakia were retrospectively studied. Operative methods were decided according to the stroboscopic observation before operation. All patients were followed up for more than 3 years. The difference between the pathology and the change of mucosal wave was analyzed. RESULTS In all patients, the mucosal wave was normal in 24 cases (33.3 %), mild weak in 25 cases (34.7 %), moderate weak in 10 cases (13.9 %), and severe weak or disappeared in 13 cases (18.1 %). The pathology was keratosis without dysplasia in 51.4 % (32/72) patients, keratosis with mild dysplasia (LIN1) in 19.4 % (14/72) patients, keratosis with moderate dysplasia (LIN2) in 12.5 % (9/72) patients, keratosis with severe dysplasia (LIN3) in 16.7 % (12/72) patients. Among LIN3 patients, 3 cases were suspected carcinoma in situ. The cure rate was 88.9 % for one operation. CONCLUSION Laryngostroboscopy can be used preoperatively in evaluation of the vocal leukoplakia. CO2 laser surgery can be used to management of the vocal leukoplakia to prevent of canceration.
【Keyword】：Stroboscopy;Leukolakia;Vocal Cords;Laser Surgery |
| | | | | | 1 | Peretti G,Piazza C,Berlucchi M,et al; Pre-and intraoperative assessment of mid-cord erythroleukoplakias:a prospective sutdy on52patients [M];Eur Arch Otorhinokaryngol; 2003年 | | 2 | Gallo A,de Vincentiis M,Della Rocca C,et al; Evolution ofprecancerous laryngeal lesions:a clinicopathologic study with long-term follow-up on259patients [M];Head Neck; 2001年 | | 3 | Colden D,Zeitels SM,Hillman RE,et al; Stroboscopic assessment of vocal fold keratosis and glottic cancer [M];Ann Otol Rhinol Laryngol; 2001年 | | 4 | Jackson C,Colledge L,Thomson S; Dicussion on precancerous conditions of the larynx [M];Proc R Soc Med; 1930年 | | 5 | Crissman JD,Fu YS; Intraepithelial neoplasia of the larynx.A clinicopathologic study of six cases with DNA analysis [M];Arch Otolaryngol Head Neck Surg; 1986年 | | 6 | Peretti G,Nicolai P,Piazza C,et al; Oncologic results of endoscopic resections of Tis and T1glottic carcinomas by carbon dioxide laser [M];Ann Otol Rhinol Laryngol; 2001年 | | 7 | Haas E,Bildstein P; The signi-cance of stroboscopy in the early diagnosis of vocal cord cancer(Author’s trans) [M];Laryngol Rhinol Otol(Stuttg); 1974年 | | 8 | Zeitels SM; Premalignant epithelium and microinvasive cancer of the vocal fold:the evolution of phonomicrosurgical management [M];Laryngoscope; 1995年 |
|
| | | | | | 1 | 宋磊,张涛源; 喉的癌前病变 [J];山西医药杂志; 2006年08期 | | 2 | 覃扬达,梁建平; 喉的癌前病变 [J];中国医学文摘.老年医学; 2004年02期 |
|
| | | | | | 1 | 龚启荣,吴坚; 穿透性角膜移植65例临床总结 [J];江苏医药; 1993年09期; 10-12 | | 2 | 徐仲明,丁恩深,文锦; 9例增生性喉白斑的临床病理分析 [J];实用医院临床杂志; 1994年02期; 37-39 | | 3 | Barth V et Pilorget J
,秦家凤; 喉动态镜 [J];国际耳鼻咽喉头颈外科杂志; 1985年02期; 22-24 | | 4 | 张均超,李卫东,黄毅平; 纤维喉镜下微波治疗声带白斑25例疗效观察 [J];新乡医学院学报; 2006年04期; 58-59 | | 5 | 陈争明,范静平,杨毓梅,周舒; 63例声带白斑的嗓音分析 [J];第二军医大学学报; 2006年08期; 20-22 | | 6 | 郑光荣; 用光纤动态镜检查声带法 [J];国际耳鼻咽喉头颈外科杂志; 1981年06期; 48 | | 7 | 黄忠华,张应霖; 动态镜检查对声嘶病人的诊断价值 [J];国际耳鼻咽喉头颈外科杂志; 1992年05期; 40-41 | | 8 | 叶酸有助于预防咽喉癌 [J];中国乡村医药; 2007年04期; 81 | | 9 | 金启祥; 伏-小柳-原田综合征 [J];国际皮肤性病学杂志; 1982年02期; 59 | | 10 | 傅德明; 喉粘膜白斑会癌变吗 [J];医药与保健; 2002年08期; 48 |
|
|
|
