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～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，18例治愈，另2例复发后再进行抗生素治疗治愈；24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。

Clinical characteristic and treatment of laryngeal scleroma]

OBJECTIVE: To study the clinical manifestation and treatment of the laryngeal scleroma METHODS: Forty-three patients with laryngeal scleroma, from May, 1981 to December, 2002, with pathological diagnosed were reviewed retrospectively. The clinical features and the treatment methods of these patients were analysed. RESULTS: All 43 cases had hoarseness and 19 of them manifested dyspnea. In the larynx, the main scleromatous lesions were classified as atrophic stage in 2 cases, as granulomatous in 35 cases and as scarring in 6 cases. The preponderance lesions were located in the glottis in 13 cases, in the subglottis in 1 case, in both supraglottis and glottis in 18 cases, in both glottis and subglottis in 8 cases, and in all the three regions of the larynx in 3 cases. Twenty-four patients were treated with antibiotics, seven patients with surgery and two patients with radiotherapy. Eighteen of 24 patients who were treated with antibiotics were cured, and two of the recurrent patients were cured with a further period of antibiotics therapy. Four of the 24 patients with second or third degree of laryngeal obstruction required prophylactic tracheostomy. One patient in granulomatous stage with the second degree of laryngeal obstruction was cured with the combination of surgery and antibiotics therapy. Six patients in the scarring stage with laryngeal stenosis were cured with reconstruction surgery. One patient treated with radiotherapy recurred in the fourth year after treatment, and one patient failed to antibiotics therapy cured with radiotherapy combined with antibiotics therapy. CONCLUSIONS: Scleroma may involve the larynx and cause dysphonia and laryngeal obstruction. Antibiotics therapy is effective in most cases with laryngeal scleroma, and the long-time follow-up after treatment were necessary. Laryngeal reconstructions were necessary for the patients with cicatrical laryngeal stenosis.