Department of Otorhinolaryngology-Head and Neck Surgery and Beijing Institute of Otorhinolaryngology, Beijing Tongren Hospital Affiliated to Capital Medical University; Key Laboratory of Otolaryngology Head and Neck Surgery, Ministry of Education, Beijing 100730, China.
Chin Med J (Engl). 2013;126(18):3523-7.
Leukokeratosis of the vocal cords is a clinical descriptive diagnosis, which includes a group of squamous intraepithelial lesions of the vocal cord mucosa. We investigated the clinical classification and treatment efficacy of leukokeratosis of the vocal cords.
We conducted a retrospective analysis of the medical history, laryngoscopic examinations, morphological features under a surgical microscope, and pathology results of 360 cases of leukokeratosis of the vocal cords to examine correlations among treatment modalities, therapeutic effects, and clinical features.
All cases were divided into four types based on symptoms, examination results, and treatment efficacies as follows: 21 patients had type I inflammatory leukoplakia and their vocal cord morphology and voice quality recovered after conservative therapies; 76 patients had type II frictional polyps and received CO2 laser submucosal cordectomy; 68 patients had type III sulcus vocalis and received mucosal slicing with dredging; and 195 cases had type IV simple leukokeratosis and received partial subligamental cordectomy with CO2 lasers or transmuscular cordectomy. Our treatment achieved a surgical cure rate of 90.9% (308/339), with a recurrence rate of 9.1% (31/339) and malignant transformation rate of 6.5% (22/339). All cancerous transformations occurred in type IV patients.
Choosing conservative or CO2 laser surgery based on the morphological characteristics of squamous epithelial lesions of keratinized vocal cord mucosa can maximally protect voice quality, reduce complications, and improve the cure rate.
声带角化症是一种临床描述性诊断，包括一组声带黏膜鳞状上皮内病变。我们研究了声带角化症的临床分类和治疗效果。
我们对 360 例声带角化症的病史、喉镜检查、手术显微镜下的形态特征和病理结果进行回顾性分析，以检查治疗方式、治疗效果和临床特征之间的相关性。
所有病例均根据症状、检查结果和治疗效果分为以下四型：21 例为 I 型炎性白斑，保守治疗后声带形态和嗓音质量恢复；76 例为 II 型摩擦性息肉，行 CO2 激光声带黏膜下切除术；68 例为 III 型声门沟，行黏膜切开疏通术；195 例为 IV 型单纯角化症，行 CO2 激光或经肌层声带部分切除术。我们的治疗手术治愈率为 90.9%（308/339），复发率为 9.1%（31/339），恶变率为 6.5%（22/339）。所有恶变均发生在 IV 型患者中。
根据角化性声带黏膜鳞状上皮病变的形态特征选择保守或 CO2 激光手术，可最大限度地保护嗓音质量，减少并发症，提高治愈率。
