【摘要】 目的分析声带白斑临床因素对预后的影响,比较CO₂激光与喉显微手术切除声带白斑的疗效。方法回顾性分析2010年1月²012年12月收治的60例声带白斑患者的临床资料。分析患者性别、年龄、吸烟、饮酒、胃食管反流、手术方式与声带白斑预后的关系。按数字随机法将患者分成常规组30例,激光组30例。常规组患者采用支撑喉镜下冷器械喉显微手术,激光组采用支撑喉镜下CO₂激光切除声带白斑病变组织。常规组和激光组患者均在术前1周,术后1周、1个月和3个月分别行电子喉镜、频闪喉镜检查、GRBAS、VHI主观评分和客观嗓音分析。结果 60例声带白斑患者中,长期吸烟51例（85.00%）,长期饮酒49例（81.67%）,伴胃食管反流35例（58.33%）。多因素分析表明,患者的性别、年龄、吸烟、饮酒和胃食管返流在声带白斑的复发和声带白斑恶变的影响差异均无统计学意义（P>0.05）。研究结果显示,术后1周声带白斑激光组的声带伤口恢复略好于常规组术后1周患者。而激光组和常规组患者电子喉镜检查、频闪喉镜黏膜波观察和主客观嗓音分析在术后1³个月结果统计分析差异无统计学意义（P>0.05）。激光组和常规组患者,在术后1⁴年进行随访,随访的结果是常规组的复发率明显高于激光组复发率（6.67%,2/30）。结论声带白斑发病与吸烟、饮酒、胃食管反流相关,但在其复发及恶变影响方面无统计学意义（P>0.05）。常规组近期效果较激光组稍好,但声带白斑治疗的远期效果CO₂激光喉显微手术疗效优于常规手术。更多还原

【Abstract】 Objective To analyze clinical factors affecting the prognosis of the vocal cord leukoplakia and compare the curative effect of CO₂ laser and laryngeal microsurgery resection for this disease.Methods Clinical data of 60 patients suffering from vocal cord leukoplakia surgically treated in our hospital from Jan 2010 to Dec 2012 were analyzed retrospectively.The relationships between the prognosis of vocal cord leukoplakia and patients’ gender,age,smoking,drinking,gastroesophageal reflux,operation method were analyzed.All the 60 patients were randomly divided into conventional group and laser group,30 cases in each group.The patients in the conventional group received laryngeal microsurgery under suspension laryngoscope while those of the laser group received focus resection with CO₂ laser.Electronic laryngoscopy,stroboscopic laryngoscopy,GRBAS,VHI subjective scoring and objective voice analysis were performed to all patients before operation,1 week,1 month and 3 months after operation.Results Of all the 60 patients,the number of cases with history of long-term smoking,drinking and gastroesophageal reflux were 51（85.00%）,49（81.67%）,and 35（58.33%） respectively.Multi-factor analysis revealed that the influences of patient’s gender,age,smoking,drinking,gastroesophageal reflux on recurrence and malignant change of vocal cord leukoplakia were statistically insignificance（all P > 0.05）.Postoperative evaluations showed that the recovery of vocal cord wound in the laser group was slightly better than that of the conventional group at 1 week after operation.The result differences of electronic laryngoscopy,stroboscopic laryngoscopy,subjective and objective voice analyses between the two groups at 1 month to 3 months after operation were all statistically insignificance（all P > 0.05）.Postoperative long-term follow-up（1 year to 4 years） showed that the recurrence rate of the laser group（6.67%,2/30） was obviously lower than that of the conventional group（20%,6/30）.Conclusion Smoking,drinking and gastroesophageal reflux are associated with the incidence of vocal cords leukoplakia,but not with its recurrence and malignant transformation.As for the therapeutic effect,laryngeal microsurgery is slightly better than CO₂ laser in short-term,while the latter is superior to laryngeal microsurgery in long-term.更多还原