喉硬结病的临床特点与治疗

目的　探讨喉硬结病的临床特点和治疗方法。方法　回顾性分析 1981年 5月～ 2 0 0 2年12月收治的 4 3例经病理证实的喉硬结病患者的临床资料和治疗方法。结果　 4 3例中声嘶 4 3例次、呼吸困难 19例次。喉部病变以萎缩期为主 2例 ,肉芽肿期为主 35例 ,瘢痕期为主 6例。主要病变局限于声门区 13例 ,局限于声门下区 1例 ;累及声门上区和声门区 18例 ,累及声门区和声门下区 8例 ,声门上区、声门区和声门下区均受累 3例。采用抗生素治疗 2 4例 ,手术治疗 7例 ,放射治疗 2例。采用抗生素治疗 2 4例中 ,18例治愈 ,另 2例复发后再进行抗生素治疗治愈 ;2 4例中 4例伴 2度或 3度喉阻塞者行预防性气管切开术。 1例伴 2度喉阻塞的肉芽肿期患者采用手术和抗生素结合的方法治愈。 6例伴喉狭窄的瘢痕期患者通过手术成形治愈。 1例采用放射治疗后 4年复发 ,1例抗生素治疗无效的患者采用放射治疗与抗生素结合的方法治愈。结论　硬结病可侵犯喉部导致发声困难和喉阻塞 ,抗生素治疗对多数喉硬结病患者有效 ,治疗后有必要进行长期随访。对喉硬结病导致瘢痕性喉狭窄的患者需手术成形。     

喉科学

20050491喉硬结病的临床特点与治疗/孙彦…//中华耳鼻咽喉科杂志.2004,39(12).737～740目的:探讨喉硬结病的临床特点和治疗方法。方法:回顾性分析1981年5月～2002年12月收治的43例经病理证实的喉硬结病患者的临床资料和治疗方法。结果:43例中声嘶43例次、呼吸困难19例次。喉部病变以萎缩期为主2例,肉芽肿期为主35例,瘢痕期为主6例。主要病变局限于声门区13例,局限于声门下区1例;累及声门上区和声门区18例,累及声门区和声门下区8例,声门上区、声门区和声门下区均受累3例。采用抗生素治疗24例,手术治疗7例,放射治疗2例。采用抗生素治疗24例中,…     

手术治疗呼吸道硬结病19例报告

为探讨手术治疗呼吸道硬结病的疗效，对经手术治疗的19例呼吸道硬给病患者的临床资料进行回顾分析。结果提示，对病变严重，且增殖致鼻腔、咽部阻塞或病变侵及鼻窦的肉芽肿期患者，手术与抗生素配合使用有助于提高疗效；对伴Ⅱ度以上喉阻塞者应行气管切开术；对后遗鼻腔、咽、喉及气管瘢痕性狭窄或闭锁的患者需手术成形。并就手术注意事项进行讨论。     

硬结症后遗声门下瘢痕狭窄的外科处理

硬结症是一种慢性、特殊性,肉芽肿性炎症,易侵犯呼吸道粘膜,多累及喉声门下区,形成慢性瘢痕性狭窄。如果病变向下蔓延,将引起气管狭窄。呼吸道狭窄一旦发生,只能用手术方法修复。作者们统计了埃及Kasr El-Aini医院耳鼻喉科1977～1978两年内2,410例门诊病人中,发现51例硬结症患者,发病率为2.1％,女多于男,为3:1。有家族史者3人。累及喉部者22例,占硬结症患者之43％,其中20例发生声门下狭窄患者年龄从10～48岁,女15,男5,均在1～4年前作过气管切开。这些患者经局部检查,确保无活动性炎症;全身检查,证明适合手术;再经喉部放射线检查(包括断层片,喉部造影片)以了解瘢痕形成的范围后,进行了手术治疗。手术步骤:氟烷全麻。行颈部正中纵切口,暴露喉和气管上部。去除瘢痕组织者14例,创面     

呼吸道硬结病致瘢痕性喉狭窄的手术治疗

目的：探讨呼吸道硬结病致瘢痕性喉狭窄的临床特点和治疗方法。方法：回顾性分析7例导致瘢痕性喉狭窄的呼吸道硬结病的临床资料和治疗方法。结果：对4例单纯喉瘢痕性喉狭窄者,行喉裂开成形术,术后随访7-14年,无复发;喉及颈段气管瘢痕性狭窄2例,行喉气管成形腔内扩张术和舌骨肌瓣成形术各1例,术后分别随访6年和8年,均无复发;1例声门下狭窄患者术后声门下腔宽敞,但术后3个月复查时,肉芽肿病变增生致声门下闭锁,手术失败。结论：瘢痕性喉狭窄应根据不同的病变部位采取相应的手术方式,术中须避免过多的粘膜损伤,以防再度狭窄;对严重的喉气管狭窄者应用粘膜瓣、骨肌瓣等组织充分增加狭窄部的管壁以解除狭窄。     

喉有蒂息肉所致的突发性气道阻塞

喉息肉所致的急性上呼吸道阻塞极为罕见,但遇到大的带蒂息肉这种现象就可出现。如发现以下症状就应高度警惕喉部带蒂息肉的存在:运动性呼吸困难;剧烈的干咳;咽喉部有持续性的清除动作;喉部肿块感;间歇性吞咽困难和/或发声困难。呕吐、剧咳、任何上气-消化道的操作均可促使息肉坠入、填塞喉入口继发喉痉挛而发生窒息。软组织的侧位片可提供有价值的诊断依据,多轨迹断层摄片在诊断蒂状息肉时更为可靠,甚至超过CT,因CT扫描声门上区时肿块可能在声门下,而当声门下区CT扫描时,则肿块又可能在声门上,但前后位断层片均可显示,为防止喉阻塞不宜选用喉部造影。     

声带突肉芽肿

回顾1982年1月～1992年12月经治组织学证实的声带突肉芽肿34例。症状：声嘶、喉部阻塞感、呼吸困难、咳嗽、咯血等。病因：滥用嗓音、气管插管、喉手术、喉术后放疗和胃酸返流。其中9例为原发性者。治疗：手术切除为主，辅以语言治疗、抗生素、激素及维生素。本病易复发，每个患者平均手术27次。最近5例喉部CT扫描均示构状软骨放射密度增高。成人构状软骨及肌突钙化而声带突无钙化、且钙化为对称性的。故本组息侧的状软骨放射密度增高并非随年龄的正常钙化表现，而是继发于软骨膜炎的病理性构状软骨钙化所致。声门处的肉芽肿似为“病理冰山…     

喉前连合癌的习性

临床上通常把喉部肿瘤分为声门上型、声门型和声门下型,是根据其原发部位来分的,各又有其解剖学上的特点,影响其生长和扩展。据此,Alonso(1947)首先采用了声门上水平喉切除术来治疗声门上喉癌,甚至当肉眼看来肿瘤已紧邻声门时,其切除面的下界也仅切到声带上缘。Bocca(1976)根据随访的发现,认为“从肿瘤学观点看来,这是一种唯一保留喉基本功能的好手术”。     

声门上区喉淀粉样变3例并文献复习

目的 探讨临床上易误诊为恶性肿瘤的声门上区喉淀粉样变的临床特点及诊治措施.方法 对3例声门上区喉淀粉样变患者行喉显微镜下CO₂激光辅助喉部病变切除术,并对临床资料进行分析.结果 3例患者均经喉显微镜CO₂激光手术治愈,术后随访1~2年,未复发.结论 喉淀粉样变临床表现缺乏特异性,但病理切片刚果红染色阳性可确诊本病;喉显微镜CO₂激光手术是有效的喉淀粉样变治疗手段.     

鼻硬结病的临床及病理研究

目的　鼻硬结病是一种少见的慢性感染性肉芽肿疾病,通过回顾性观察鼻硬结病的临床病理学和组织学特点,初步探讨鼻硬结病的发病、发展及转归。方法　以43例鼻硬结病患者的组织标本为研究对象,用HE及组织化学Warthin-Starry（W-S）染色,其中13例组织分别用CD43（T淋巴细胞）、CD20（B淋巴细胞）、CD68（巨噬细胞）、溶菌酶抗体免疫组化ABC法染色。结果　全部标本均检测到鼻硬结杆菌,W-S染色和电镜观察均在Mikulicz细胞内检测出大量鼻硬结杆菌。全部患者采用抗生素治疗,13例辅助手术治疗,3例辅助放疗。随访1～26年,11例复发,31例一次治愈,1例未控。结论　临床和组织学特征分析有助于鼻硬结病早期诊断。宿主细胞免疫功能障碍是潜在致病机制。以抗生素为主包括放疗和手术的综合治疗可以有效清除鼻硬结杆菌感染。     

Laryngeal scleroma.

Respiratory scleroma is a chronic, progressive granulomatous disease of the respiratory tract. The causal organism is the Klebsiella rhinoscleromatis. The disease has three stages: the initial catarrhal stage, granulomatous stage, and sclerotic stage. The object of this report was to determine the clinical behaviour of the laryngeal scleroma. The study included 17 patients with this manifestation characterized by airway obstruction and dysphonia. The report revealed that respiratory scleroma affected the larynx in 40%, and the principal findings were glottic/subglottic stenosis.     

Therapeutic outcomes of laryngeal cancer at Kyoto University Hospital for 10 years

CONCLUSION: It is important to prevent regional lymph node recurrence and distant metastasis to achieve better survival of laryngeal cancer. OBJECTIVE: Therapeutic outcomes of 130 cases with laryngeal cancer treated at Kyoto University Hospital between 1995 and 2004 were reviewed. PATIENTS AND METHODS: In all, 121 males and 9 females were involved. Their ages ranged from 40 years to 92 years (average 66 years). All tumors were squamous cell carcinoma - arising at the glottis in 111 cases, the supraglottis in 18, and the subglottis in 1 case. Most glottic cancers (77.5%) were classified as stage I or II, while most supraglottic cancers (77.8%) were at stage III or IV. Stage I/II cancers were basically treated by conventional radiotherapy (60-66 Gy) and twice-daily hyperfractionated radiotherapy (70-74 Gy), respectively, attempting to preserve the larynx. Total laryngectomy with neck dissection was performed in the treatment of stage III/IV cases. RESULTS: Five-year disease-specific survival rates were 100%, 96%, 100%, and 68% for stage I, II, III, and IV, respectively. Five-year laryngeal preservation rates were 98%, 100%, 86%, 0%, and 0% for T1a, T1b, T2, T3, and T4 of glottic cancer, respectively. Local recurrence occurred in five cases of stage I/II glottic cancer, which was successfully salvaged. Regional lymph node recurrence occurred in five cases including four patients with glottic cancer and one with supraglottic cancer. Two of them died of disease despite undergoing salvage therapy. Distant metastasis occurred in the lung in four cases including one glottic and three supraglottic cancer patients after initial treatment.     

Scleroma of the upper respiratory passages: a CT study

Scleroma is a chronic specific granulomatous disease endemic in Egypt. The nasal cavities were all affected in the 37 patients examined. The paranasal sinuses and nasopharynx were involved in 17 patients, while the larynx and upper trachea were affected in five patients, four of whom were females. Twenty-three patients were in the granulomatous stage; the rest of the patients were in the atrophic and fibrotic stages. The main nasal and nasopharyngeal CT findings were soft tissue masses of variable sizes. The lesions were characteristically homogenous, non-enhancing and had distinct edge definition; adjacent fascial planes were not invaded. The subglottic area was involved in laryngeal and tracheal scleroma. The lesions were mainly in the form of concentric irregular narrowing of the airway. In the trachea, crypt-like irregularities were diagnostic of scleroma. Intra-orbital, intra-cranial and infratemporal parapharyngeal scleromatous masses were detected in one patient.     

非鳞状细胞来源声门下区肿物的诊断与治疗

目的：探讨非鳞状细胞来源声门下区肿物的临床特征,诊断、病理类型和治疗方法,提高对这一罕见疾病的认识。方法：分析3例非鳞状细胞来源声门下区肿物患者的临床资料,结合相关文献,总结非鳞状细胞来源的声门下区肿物的临床表现、诊断和治疗经验。结果：3例患者中,1例以声嘶为主要症状,2例以吸气性呼吸困难为主要症状;3例在明确诊断及解除喉梗阻后均行声门下区肿物切除手术,其中2例经口行支撑喉镜下手术切除,1例经颈部入路切开环甲膜后行肿物切除手术,均完整切除肿物。1例上皮一肌上皮癌患者采取术后放疗,疗效满意。3例随访至今,无复发。结论：声门下型非鳞状细胞来源肿物较为罕见,早期容易漏诊,临床上应对声门下区仔细检查。治疗该类疾病以手术切除为主,可根据肿物大小、范围选择适宜的手术方式。     

Radiotherapy of early glottic cancer

Patients (383) with stage Tis, Tla and Tlb NoMo glottic cancer are reviewed. Radiotherapy cured 93% of Tis patients and 86% of Tla and Tlb cases. Of all recurrences, 63% were cured. No patient with stage Tis died as a result of tumor and only 5% of stage Tla and Tlb died from tumor. Involvement of the anterior commissure or both vocal cords did not influence control rates by radiotherapy. Mobility of the vocal cord and size of radiotherapy field were significant factors influencing control by radiotherapy. Late recurrences and/or second primaries in the larynx following radiotherapy are rare. Second primaries in the respiratory tract (especially lung) are common and are as important a cause of death as laryngeal cancer in Tl cases. It is concluded that moderate dose radiotherapy with surgery for salvage is a highly effective method of management for early glottic cancer.     

Epiglottic reconstruction of laryngeal stenosis secondary to cricothyroidostomy

Two cases of laryngeal stenosis secondary to cricothyroidostomy are presented with their management. Both laryngeal injuries involved the glottis and subglottis regions with the second case sustaining total closure of the larynx by scar tissue. Although different surgical procedures were employed, management was successful in each case with one surgical attempt. Total glottic and subglottic reconstruction was necessary in the second case and was successfully handled with a modification of the epiglottic laryngoplasty. The surgical technique is described in detail. Caution is raised concerning the routine use of cricothyroidostomy. Epiglottic laryngoplasty is presented as a simple and encouraging procedure for laryngeal reconstruction of laryngeal stenosis.     

喉小涎腺癌15例临床分析

目的 探讨喉小涎腺癌的临床特点、治疗及预后.方法 回顾性分析中国医学科学院肿瘤医院头颈外科1959至2005年收治的15例喉小涎腺癌患者的临床资料.11例(73.3%)病变位于声门上区,4例(26.7%)病变位于声门下区.其中腺样囊性癌10例,腺癌2例,黏液表皮样癌、恶性混合瘤、基底细胞腺癌各1例.单独手术7例;手术+放疗7例,其中6例患者行术后放疗,1例行术前放疗;1例行放疗+化疗.治疗后4例局部复发患者行手术挽救,其中l例肺转移后行转移灶切除;1例治疗后颈转移患者行放疗.结果 随访时间2～16年,中位数为8年.治疗后局部复发4例次,颈淋巴转移1例次,远处转移5例次,其中局部复发伴远处转移3例.7例患者存活3～16年,其中5例为无瘤生存,1例行单纯手术治疗,4例行手术+放疗;4例远处转移于治疗2～10年后死亡;其余4例随访2～16年后失访.结论 喉小涎腺癌很少见,其易发生局部复发和远处转移,远处转移是最主要的死亡原因.外科手术是喉小涎腺癌的主要治疗方法 ,手术结合放疗可望提高肿瘤局部控制率.