Garrel R, Uro Coste E, Costes-Martineau V, Woisard V, Atallah I, Remacle M
Département d'ORL et CCF, hôpital Gui de Chauliac, 80, avenue Fliche, 34295 Montpellier, France.
CHU Toulouse, département d'anatomopathologie, hôpital de Rangueil, avenue Jean-Poulhes, 31400 Toulouse, France.
Eur Ann Otorhinolaryngol Head Neck Dis. 2020 Nov;137(5):399-404. doi: 10.1016/j.anorl.2020.01.008. Epub 2020 Jan 27.
Vocal-fold leukoplakia and dysplasia are together designated "epithelial hyperplastic laryngeal lesions" (EHLL). Work-up and follow-up are founded on optical examination with high-definition imaging, stroboscopy and narrow-band imaging. Diagnosis is based on pathology, using the new 2017 WHO classification, dichotomizing "low grade" and "high grade". Statistically, the risk of cancerous progression is 20% within 5 to 10 years of diagnosis, or more in over-65 year-old males; risk for any given patient, however, is unpredictable. Research focuses on the genetic criteria of the lesion and characterization of the tumoral microenvironment. Treatment is exclusively microsurgical. Resection depth is adjusted according to infiltration. EHLL is a chronic disease, necessitating long-term follow-up, which may be hampered by residual dysphonia and surgical sequelae in the vocal folds. Sequelae need to be minimized by good mastery of microsurgical technique and indications. When they occur, biomaterials such as autologous fat and hyaluronic acid can be useful. Tissue bio-engineering is a promising field.
声带白斑和发育异常统称为“上皮增生性喉部病变”（EHLL）。检查和随访基于高清成像、频闪喉镜检查和窄带成像的光学检查。诊断依据病理学，采用2017年世界卫生组织新分类法，分为“低级别”和“高级别”。从统计学角度看，诊断后5至10年内癌变进展风险为20%，65岁以上男性风险更高；然而，任何特定患者的风险都是不可预测的。研究重点在于病变的基因标准和肿瘤微环境的特征。治疗仅采用显微手术。切除深度根据浸润情况进行调整。EHLL是一种慢性病，需要长期随访，而残留的发声困难和声带手术后遗症可能会妨碍随访。需要通过熟练掌握显微手术技术和适应证将后遗症降至最低。后遗症出现时，自体脂肪和透明质酸等生物材料可能会有所帮助。组织生物工程是一个很有前景的领域。
