Ma Lijing, Xiao Yang, Ye Jingying, Yang Qingwen, Wang Jun
Key Laboratory of Otolaryngology Head and Neck Surgery (Ministry of Education of China), Department of Otolaryngology Head and Neck Surgery, Beijing Tongren Hospital, Capital Medical University , Beijing , China.
Acta Otolaryngol. 2015 Mar;135(3):277-82. doi: 10.3109/00016489.2014.986756. Epub 2015 Jan 27.
The combination of laryngeal microsurgery and local injections of botulinum toxin type A (BTA) can increase the cure rate of patients with vocal process granulomas (VPGs).
To analyze the therapeutic effects of conservative treatments, microsurgical resection with suturing and microsurgery in combination with local injections of BTA for the treatment of VPGs.
A retrospective analysis of 168 cases of VPG was performed. All of the patients initially received a conservative treatment. Some of the patients who did not respond to the conservative treatments were treated using microsurgical resection and microsuturing using an 8-0 absorbable filament. Other patients additionally received a four-point injection of BTA into the thyroarytenoid muscle and the arytenoid muscle on the operated side.
The lesions of 41.3% (71/168) of the patients who were given the conservative treatments (including acid suppression, vocal rest, and voice therapy) disappeared, and the lesions of 10.7% (18/168) of the patients were reduced. The conservative treatments were unsuccessful for 47% (79/168) of the patients. The cure rate was 78.4% (29/37) for the patients who were treated by microscope resection using a CO2 laser and microsuturing of the surrounding mucosa. Of the eight patients who experienced a recurrence, five of them had lesions that disappeared after 3 months of conservative treatment, whereas the other three patients recovered after a second operation. The cure rate of the 42 patients who were treated using microsurgery combined with local injections of BTA was 95.2% (40/42), with only 2 cases of recurrence at 2 months post-treatment.
喉显微手术与局部注射A型肉毒毒素（BTA）相结合可提高声带突肉芽肿（VPG）患者的治愈率。
分析保守治疗、显微手术切除缝合以及显微手术联合局部注射BTA治疗VPG的疗效。
对168例VPG患者进行回顾性分析。所有患者最初均接受保守治疗。部分对保守治疗无反应的患者采用显微手术切除并用8-0可吸收缝线进行显微缝合。其他患者在手术侧的甲杓肌和杓状肌额外接受四点BTA注射。
接受保守治疗（包括抑酸、禁声和嗓音治疗）的患者中，41.3%（71/168）的患者病变消失，10.7%（18/168）的患者病变减轻。47%（79/168）的患者保守治疗失败。采用CO2激光显微切除及周围黏膜显微缝合治疗的患者治愈率为78.4%（29/37）。在8例复发患者中，5例患者经3个月保守治疗后病变消失，另外3例患者二次手术后恢复。采用显微手术联合局部注射BTA治疗的42例患者治愈率为95.2%（40/42），治疗后2个月仅2例复发。
