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摘要: 目的 探讨咽喉难治性溃疡的临床特点、治疗方式及预后。 方法 对78例难治性咽喉溃疡患者的临床表现、喉镜特征、实验室检查、组织病理检查、治疗等进行回顾性分析。 结果 良性病变中男女比例无明显差异，恶性病变中男性明显多于女性。共7种病理类型，最常见的是单纯炎性溃疡(18例)、其次分别为结核(16例)、真菌(15例)、淋巴瘤(14例)、鳞状细胞癌(10例)、白塞病(3例)和髓系肉瘤(2例)。 结论 难治性咽喉溃疡的临床表现及病变类型多样，首先需通过系统、全面的病史采集、专科检查和辅助检查明确诊断，以避免误诊误治。喉镜检查和组织病理学检查是明确病变类型及指导治疗的重要辅助手段。Abstract: Objective To explore the clinical characteristics, treatment methods, and prognosis of refractory pharyngeal ulcers. Methods A retrospective analysis was conducted on the clinical manifestations, laryngoscopic features, laboratory tests, histopathological examinations, and treatments of 78 patients diagnosed with refractory pharyngeal ulcers. Results There was no significant difference in the proportion of males-to-females in benign lesions, while males were significantly more prevalent in cases of malignant lesions. Seven distinct pathological types of pharyngeal ulcers were identified, with the most common being simple inflammatory ulcers(18 cases), followed by tuberculosis(16 cases), fungi(15 cases), lymphoma(14 cases), squamous cell carcinoma(10 cases), Behcet's disease(3 cases), and myelosarcoma(2 cases). Conclusion The clinical manifestations and lesions associated with refractory pharyngeal ulcers are diverse. A clear diagnosis should be established based on a systematic and comprehensive medical history, specialized examinations, and additional tests to avoid misdiagnosis and mistreatment. Laryngoscopy and histopathological examinations are essential for identifying the type of lesion and guiding appropriate treatment.
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Key words:
- pharyngeal ulcer /
- laryngeal nucleus /
- lymphoma /
- laryngeal fungal infection
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表 1 不同类型病变患者的年龄、性别及病程分布
病变类型 例数 男 女 中位年龄/岁 平均病程/月 炎性溃疡 18 10 8 56.5 15.33±27.70 结核 16 9 7 37.0 4.13±3.54 真菌 15 4 11 35.0 3.16±5.91 淋巴瘤 14 10 4 56.0 3.71±3.22 鳞状细胞癌 10 9 1 65.0 3.30±1.42 白塞病 3 2 1 38.0 1.00±0.00 髓系肉瘤 2 2 0 52.5 3.00±1.41 合计 78 46 32 51.5 6.18±14.52 
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表 2 不同病变类型主要临床表现
例 病变类型 临床表现 咽痛 声嘶 咳嗽咳痰 咽异物感 头痛头晕 发热 吞咽困难 痰中带血 呼吸困难 炎性溃疡 15 10 6 5 3 0 2 0 0 结核 10 10 9 5 3 6 4 0 1 真菌 11 11 10 0 7 5 0 0 0 淋巴瘤 10 0 0 7 0 4 2 4 0 鳞状细胞癌 5 5 4 4 0 0 3 0 1 白塞病 3 0 2 0 2 3 2 0 0 髓系肉瘤 2 0 1 2 0 0 0 0 0 合计 56 36 32 23 15 18 13 4 2
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表 3 喉镜下病变部位分布
例 病变类型 病变部位 声带 会厌 扁桃体 咽壁 室带、杓区及梨状窝 软腭及咽弓 舌根 声门下 炎性溃疡 10 5 0 4 4 3 0 0 结核 11 8 3 4 8 2 2 1 真菌 11 3 0 4 2 0 3 2 淋巴瘤 0 3 13 5 0 5 2 0 鳞状细胞癌 5 3 3 3 3 2 2 0 白塞病 0 3 3 3 2 3 3 0 髓系肉瘤 0 2 0 1 0 0 0 0 合计 37 27 22 24 19 15 12 3
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