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声带白斑的致病因素及临床病理特征分析

[Analyses of pathogenic factors and clinicopathological characteristics of vocal leukoplakia].

作者信息

Wang W L, Zhang L H, Cao J, Li C F, Wang Y G, Zhao Y X

机构信息

Department of Otorhinolaryngology Head and Neck Surgery, Peking University People's Hospital, Beijing 100044, China.

出版信息

Zhonghua Er Bi Yan Hou Tou Jing Wai Ke Za Zhi. 2018 Aug 7;53(8):581-586. doi: 10.3760/cma.j.issn.1673-0860.2018.08.005.

Abstract

To investigate the pathogenic factors of vocal leukoplakia and its clinical and pathological features. Eighty-one patients with vocal cord leukoplakia who underwent surgery between February 2010 and December 2016 and 160 volunteers without pharyngeal symptoms designed as controls were included in this case control study. The clinicopathological characteristics of 81 patients were summarized and analyzed synthetically. There was statistical significance in reflux symptom index(RSI), reflux finding score(RFS), smoking index, and drinking index between case group and control group(=-5.35, -4.82, -4.76, -2.44, <0.05). The voice-using duration per day in case group was significantly longer than that of control group.There was no statistical significance in hospital anxiety and depression scale for anxiety(HADA) scores、hospital anxiety and depression scale for depression(HADD) scores between case group and control group(>0.05). In 42 patients who received 24-hour dual probe pH monitoring the prevalence of pathologic LPR was 42.8%. In 81 patients, 39(48%)patients were pathologically diagnosed as squamous cell hyperplasia, 18(22%)patients as mild dysplasia, 12(15%)sides as moderate dysplasia , 10(12%)patients as severe dysplasia and 2(2%)patients as carcinoma -. The average age of high-risk pathological vocal leukoplakia was significantly higher than that of low-risk leukoplakia(=-2.73, <0.01). The propotion of speckled leukoplakia in high-risk leukoplakia was significantly higher than that of low-risk leukoplakia(χ(2)=23.81, <0.01). There was no statistical significance between high-risk leukoplakia and low-risk leukoplakia in the prevalence of pathologic LPR(>0.05). The bilateral lesions, speckled leukoplakia were more likely to relapse(χ(2)=4.27, 12.17, <0.05). The more serious the pathology, the more likely it was to relapse (=-2.168, =0.03). There was no statistical significance between recurrence group and non-recurrence group in the prevalence of pathologic LPR(>0.05). LPR, smoke constitute the risk factors of vocal cord leukoplakia. Drinking, voice abuse are related to vocal cord leukoplakia. Senile, speckled leukoplakia are more likely to be malignancy. A speckled leukoplakia, bilateral leukoplakia, severe pathological degree are important factors to predict recurrence.

摘要

探讨声带白斑的致病因素及其临床和病理特征。本病例对照研究纳入了2010年2月至2016年12月期间接受手术的81例声带白斑患者以及160名无咽部症状的志愿者作为对照。综合总结并分析了81例患者的临床病理特征。病例组与对照组在反流症状指数(RSI)、反流发现评分(RFS)、吸烟指数和饮酒指数方面存在统计学意义(=-5.35,-4.82,-4.76,-2.44,<0.05)。病例组每天的用嗓时长显著长于对照组。病例组与对照组在医院焦虑抑郁量表焦虑(HADA)评分、医院焦虑抑郁量表抑郁(HADD)评分方面无统计学意义(>0.05)。在42例行24小时双探头pH监测的患者中,病理性喉咽反流的患病率为42.8%。81例患者中,39例(48%)病理诊断为鳞状上皮增生,18例(22%)为轻度不典型增生,12例(15%)为中度不典型增生,10例(12%)为重度不典型增生,2例(2%)为癌。高危病理性声带白斑患者的平均年龄显著高于低危白斑患者(=-2.73,<0.01)。高危白斑中斑点状白斑的比例显著高于低危白斑(χ(2)=23.81,<0.01)。高危白斑与低危白斑在病理性喉咽反流患病率方面无统计学意义(>0.05)。双侧病变、斑点状白斑更容易复发(χ(2)=4.27,12.17,<0.05)。病理越严重,越容易复发(=-2.168,=0.03)。复发组与未复发组在病理性喉咽反流患病率方面无统计学意义(>0.05)。喉咽反流、吸烟是声带白斑的危险因素。饮酒、用嗓过度与声带白斑有关。老年、斑点状白斑更易恶变。斑点状白斑、双侧白斑、病理程度严重是预测复发的重要因素。

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