声带白斑形态分型与选择性保守治疗预后相关性分析

陈敏; 吴海涛; 杨越; 陈健; 黎长江; 石芳

doi:10.13201/j.issn.1001-1781.2018.16.012

声带白斑形态分型与选择性保守治疗预后相关性分析

- 复旦大学附属眼耳鼻喉科医院耳鼻咽喉头颈外科上海市耳鼻咽喉科学重点实验室(上海, 200031)
基金项目:
上海市科学技术委员会科研计划项目（No：15401971600）

详细信息

通讯作者: 吴海涛,E-mail:eentwuhaitao@163.com

中图分类号: R767.4

收稿日期: 2018-03-29

Association between the morphological classification and prognosis of conservative treatment for vocal fold leukoplakia

- Department of Otolaryngology Head and Neck Surgery, Eye Ear Nose and Throat Hospital, Fudan University, Shanghai Key Clinical Disciplines of Otorhinolaryngology, Shanghai, 200031, China

More Information

Corresponding author: WU Haitao, E-mail: eentwuhaitao@163.com

Received Date: 29 March 2018

摘要

摘要: 目的：探讨声带白斑形态分型与选择性保守治疗预后的相关性。方法：对不同形态分型的声带白斑患者先进行保守治疗，其中保守治疗未治愈及治愈后复发者采用CO₂激光手术切除治疗，回顾性分析三种形态分型声带白斑患者的疗效。结果：236例声带白斑包括78例平坦光滑型，146例隆起光滑型和12例粗糙型，保守治疗的治愈率分别为80.8%、65.1%和0%（P<0.01），其中158例获得治愈的患者1年内复发率为10.1%（平坦光滑型与隆起光滑型的复发率分别为6.3%和12.6%，P=0.283）。78例保守治疗未治愈及16例治愈后复发的声带白斑患者行CO₂激光切除术，其中平坦光滑型、隆起光滑型和粗糙型声带白斑患者的治愈率分别为89.5%、85.7%和75.0%（P=0.53）；三组声带白斑病理构成均存在显著差异。平坦光滑型、隆起光滑型和粗糙型声带白斑患者经保守治疗结合手术治疗的治愈率分别为97.4%、93.8%和75.0%，其中平坦光滑型的治愈率显著高于粗糙型（P=0.002）。结论：声带白斑的形态分型可作为选择性保守治疗的依据，选择性保守治疗结合手术治疗并不影响声带白斑的预后。
- 声带白斑 /
- 形态分型 /
- 保守治疗 /
- 手术治疗
Abstract: Objective: To explore the association between the morphological classification and prognosis of conservative treatment for vocal fold leukoplakia. Method: Patients with different types of vocal fold leukoplakia received conservative treatment first. Those who had failed response to conservative treatment or recurred received carbon dioxide laser resection. Then the efficacy and recurrence rate were compared among the three types of vocal fold leukoplakia. Result: Two hundred and thirty-six patients consisted of 78 flat and smooth cases, 146 bulge and smooth cases, and 12 rough cases. The complete response rate of conservative treatment for the three types was 80.8%, 65.1%, and 0%, respectively (P<0.01). Out of 158 patients who had complete response to conservative treatment, 10.1% cases recurred in 1 year (flat and smooth vs. bulge and smooth, 6.3% vs. 12.6%, P=0.283). Totally, 78 patients had no complete response to conservative treatment and 16 patients experienced recurrence, whose complete response rate of carbon dioxide resection was 89.5%, 85.7%, and 75.0%, respectively (P=0.53). The pathological results were significantly different among three types. The complete response rate of conservative treatment combined with surgery for three types was 97.4%, 93.8%, and 75.0%, respectively, and the complete response rate of flat and smooth type was significantly higher than that of rough type (P=0.002). Conclusion: The Conservative treatment could be based on the morphological classification of vocal fold leukoplakia. The treatment modality that conservative treatment combined with surgery had no impact on the prognosis of vocal fold leukoplakia.
- vocal fold leukoplakia /
- morphological classification /
- conservative treatment /
- surgical treatment

HTML全文

参考文献(25)

[1]	FERLITO A, DEVANEY K O, WOOLGAR J A, et al. Squamous epithelial changes of the larynx:diagnosis and therapy[J]. Head Neck,2012,34:1810-1816.
[2]	MAU T. Diagnostic evaluation and management of hoarseness[J]. Med Clin North Am, 2010, 94:945-960.
[3]	CHA W, YOON B W, JANG J Y, et al. Office-based biopsies for laryngeal lesions:Analysis of consecutive 581 cases[J]. Laryngoscope,2016,126:2513-2519.
[4]	THOMPSON L. World Health Organization classification of tumours:pathology and genetics of head and neck tumours[J]. Ear Nose Throat J, 2006, 85:74.
[5]	WELLER M D, NANKIVELL P C, MCCONKEY C, et al. The risk and interval to malignancy of patients with laryngeal dysplasia; a systematic review of case series and meta-analysis[J]. Clin Otolaryngol,2010,35:364-372.
[6]	KARATAYLI-OZGURSOY S, PACHECO-LOPEZ P, HILLEL A T, et al. Laryngeal dysplasia, demographics, and treatment:a single-institution, 20-year review[J]. JAMA Otolaryngol Head Neck Surg,2015,141:313-318.
[7]	MEHANNA H, PALERI V, ROBSON A, et al. Consensus statement by otorhinolaryngologists and pathologists on the diagnosis and management of laryngeal dysplasia[J]. Clin Otolaryngol,2010,35:170-176.
[8]	PARKER N P. Vocal fold leukoplakia:incidence, management, and prevention[J]. Curr Opin Otolaryngol Head Neck Surg,2017,25:464-468.
[9]	ZHANG N, CHENG L, CHEN M, et al. Relationship between laryngoscopic and pathological characteristics of vocal cords leukoplakia[J]. Acta Otolaryngol, 2017, 137:1199-1203.
[10]	AHN A, WANG L, SLAUGHTER J C, et al. Serial full-thickness excision of dysplastic vocal fold leukoplakia:Diagnostic or therapeutic[J]? Laryngoscope,2016, 126:923-927.
[11]	MA L J, WANG J, XIAO Y, et al. Clinical classification and treatment of leukokeratosis of the vocal cords[J]. Chin Med J (Engl),2013,126:3523-3527.
[12]	ISENBERG J S, CROZIER D L, DAILEY S H. Institutional and comprehensive review of laryngeal leukoplakia[J]. Ann Otol Rhinol Laryngol,2008,117:74-79.
[13]	CUI W, XU W, YANG Q, at al. Clinicopathological parameters associated with histological background and recurrence after surgical intervention of vocal cord leukoplakia[J]. Medicine (Baltimore),2017,96:e7033.
[14]	FANG T J, LIN W N, LEE L Y, et al. Classification of vocal fold leukoplakia by clinical scoring[J]. Head Neck,2016,38(Suppl 1):E1998-2003.
[15]	GALE N, GNEPP D R, POLJAK M, et al. Laryngeal Squamous Intraepithelial Lesions:An Updated Review on Etiology, Classification, Molecular Changes, and Treatment[J]. Adv Anat Pathol,2016,23:84-91.
[16]	YOUNG C K, LIN W N, LEE L Y, et al. Laryngoscopic characteristics in vocal leukoplakia:inter-rater reliability and correlation with histology grading[J]. Laryngoscope,2015,125:E62-66.
[17]	PANWAR A, LINDAU R 3rd, WIELAND A. Management of premalignant lesions of the larynx[J]. Expert Rev Anticancer Ther,2013,13:1045-1051.
[18]	XU J, XUE T, BAO Y, et al. Positive therapy of andrographolide in vocal fold leukoplakia[J]. Am J Otolaryngol,2014,35:77-84.
[19]	ALMADORI G, BUSSU F, NAVARRA P, et al. Pilot phase IIA study for evaluation of the efficacy of folic acid in the treatment of laryngeal leucoplakia[J]. Cancer,2006,107:328-336.
[20]	徐川东,于海娜,王立宁,等. 中药蒸汽雾化吸入疗法治疗声带良性增生性病变的疗效观察[J]. 中国中西医结合耳鼻咽喉科杂志,2015,23(6):434-438.
[21]	DISPENZA F, DE STEFANO A, MARCHESE D, et al. Management of laryngeal precancerous lesions[J]. Auris Nasus Larynx,2012,39:280-283.
[22]	MINNI A, BARBARO M, RISPOLI G, et al. Treatment with laser CO₂ cordectomy and clinical implications in management of mild and moderate laryngeal precancerosis[J]. Eur Arch Otorhinolaryngol,2008,265:189-193.
[23]	CHEN M, CHEN J, CHENG L, et al. Recurrence of vocal fold leukoplakia after carbon dioxide laser therapy[J]. Eur Arch Otorhinolaryngol,2017,274:3429-3435.
[24]	YANG S W, CHAO W C, LEE Y S, et al. Treatment outcome of vocal cord leukoplakia by transoral laser microsurgery[J]. Lasers Med Sci,2017,32:19-27.
[25]	LEE D H, YOON T M, LEE J K, et al. Predictive factors of recurrence and malignant transformation in vocal cord leukoplakia[J]. Eur Arch Otorhinolaryngol,2015,272:1719-1724.