喉接触性肉芽肿临床分析及治疗方法探讨

目的：探讨喉接触性肉芽肿的临床特点及治疗方法。方法：回顾性分析我科2005-01-2012—12期间13例有完整资料的喉接触性肉芽肿的发病特点、相关病因、临床表现及治疗方法，比较保守治疗及手术治疗疗效并探讨其治疗方法选择。结果：喉接触性肉芽肿好发于男性（84．6％），其相关病因以胃食管返流病、慢性咳嗽及习惯性清嗓病史、气管插管病史多见，无明显病因亦占重要比例（38．4％）。临床表现以喉异物感、说话易疲劳、声嘶多见，无任何喉部症状占30．7％。手术治疗6例，初次复发率为66．6％，1次及2次手术后有效率为50．0％。保守治疗7例，抗胃食管返流、避免过度用嗓、减少习惯性清嗓动作以及未予药物治疗，有效率为57．1％。2组总有效率为53．8％，2组间疗效比较差异无统计学意义。结论：目前喉接触性肉芽肿治疗疗效较差，治疗方案尚无统一标准，应采取个体化治疗。首选针对病因保守治疗，对于有明显声音嘶哑或肉芽肿过大影响呼吸者可考虑手术治疗。

The clinical analysis and treatment of contact granuloma of larynx

Objective：To explore the clinical features and treatments of contact granuloma of larynx. Method： To find the best treatments by analyzing the clinical features, related causes and the treatments of the 13 contact granuloma of larynx cases, which have complete data, of our department from Jan 2005 to Dec 2012, also by comparing the effect of conservative treatment and operation treatment. Result： Contact granuloma of larynx is more common in men （84.6% ）. The main causes are gastro esophageal reflux, chronic cough, habitual hawk and endotracheal intubation disease. However, a big part （38.4 %） gets the disease without any other disease history. The main clinical feature of the disease includes： sensation of foreign matter in throat, easy to get exhausted when talking and voice hoarse, but also 30.7% without any feature in throat. Among the 13 cases, 6 were treated by operation and the first recurrence was 66.6%. The cure rate was 50% after one or two operations. The other 7 were treated in conservative way, including anti- Gastro esophageal reflux, avoiding excessive talking, reducing habitual hawk ,or without any medical treatment. The cure rate was 57.1%. The total cure rate was 53.8%. However, it is nonsense to comparing the two different treatments （x2 = 0. 066, P〉0.05）. Conclusion：There is still no standard treatment for contact granuloma of larynx and the effect is not good enough. The treatment should be depending on individual case. Conservative treatment is the first choice. However, operation should be considered if the pa- tient has obviously hoarse and his granuloma is too large to breathe well.