喉接触性肉芽肿的影像学及治疗研究

发布时间：2018-04-30 04:17

本文选题：喉接触性肉芽肿 + 抑酸疗法　；参考：《南方医科大学》2017年硕士论文

【摘要】：目的目前关于喉接触性肉芽肿(laryngeal contact granuloma,LCG)的机制和治疗相关研究屡见不鲜,但是研究结果并不统一,为了进一步探究该病的影响因素和有效的治疗方法,我们对其进行系列研究,拟达到以下目的:1.探讨LCG患者患侧杓状软骨高分辨率计算机体层X线摄影术(high-resolution computed tomography,HRCT)的影像学表现,并与声带癌或声带白斑患者患侧杓状软骨影像学进行比较,探索该病的发病特点。2.初步探索经甲状舌骨膜(thyrohyoid membrane,TH)法行LCG内激素注射的临床应用价值。3.探讨单纯质子泵抑制剂(proton pump inhibitor,PPI)抑酸治疗,LCG内激素注射联合PPI抑酸疗法治疗LCG的临床效果。方法1.连续收集2015年5月～2016年9月42例LCG患者治疗前喉部HRCT薄层扫描图像,并连续回顾性统计治疗前进行过喉部HRCT薄层扫描的50例喉病变组(声带癌或声带白斑)患者影像学图像,分析并比较LCG患者患侧分别与其健侧、喉病变组患者健、患侧之间的杓状软骨硬化情况。2.回顾性分析2013年2月至2015年10月我科实施的经TH径路声带病变内激素注射术治疗LCG的32例患者临床资料,对病人注射成功率、耐受性以及不良反应等情况进行跟踪记录。3.选取我科2010年3月～2014年10月诊治的88例LCG患者,采取单纯抑酸疗法治疗的67例LCG患者作为对照组,并选取同期在我科采取LCG内激素注射联合抑酸治疗的21例患者作为试验组,对其治疗效果进行对照研究。结果1.影像学研究中,42例LCG患者中,平均年龄(48.3±9.6)岁,左侧声带受累28侧,右侧受累13侧,双侧受累1例;50例喉病变组患者中,平均年龄(61.2±9.9)岁,左侧声带受累13侧,右侧受累26侧,双侧受累11例;LCG患者患侧、健侧以及喉病变组患者患侧、健侧HRCT下杓状软骨硬化率分别为79.07%(34/43)、7.32%(3/41)、13.11%(8/61)、2.56%(1/39)。LCG 患者声带患侧杓状软骨硬化现象显著多于其健侧和喉病变组健、患侧,差异均具有统计学意义(p1,2,3=0.000);LCG组患侧杓状软骨硬化的患者年龄与非硬化的在统计学上无显著差异(p=0.209)。2.32例患者中的34侧病变,经TH法LCG内注射曲安奈德共计113次,每位患者中位注射次数3次,每次注射约0.3～1.0mg,一次注射成功率100%,患者配合良好,在中位随访时间26月的随访期内未出现严重并发症。3.单纯抑酸治疗的67例LCG患者中,治愈50例(74.63%),平均治愈时间(5.31 ±0.38)月,总有效率97.01%;LCG内激素注射联合抑酸治疗的21例患者中,治愈15例(71.43%),平均治愈时间(3.80±0.43)月,总有效率95.24%;两组的治愈率差异无统计学意义(X2=0.085,p=0.771),但激素注射组的治愈时间短于对照组(Z=-2.093,p=0.036)。结论1.LCG患者患侧杓状软骨HRCT硬化率达79.07%,且与年龄无明显相关,可以作为该病的一项影像学表现,同时此现象的出现可能与病变部位长期、反复受到炎性刺激有关。2.经TH法声带注射术治疗LCG视野开阔,操作准确,成功率高,患者较易耐受,不良反应少,值得推广。3.单纯抑酸疗法与病变内激素注射结合抑酸疗法治疗LCG疗效相当,且治疗效果显著,后者可以缩短治愈时间。
[Abstract]:Objective the mechanism and treatment of laryngeal contact granuloma (LCG) is not uncommon, but the results are not uniform. In order to further explore the influencing factors and effective treatment methods of the disease, we carry out a series of studies to achieve the following objectives: 1. to explore the diplike soft side of the patients with LCG. Imaging findings of high-resolution computed tomography (HRCT) with bone high resolution computer, and compared with cricoarytenoid cartilage imaging in patients with vocal cord cancer or vocal cords leukoplakia, to explore the pathogenesis of the disease, and to explore the clinical application of thyrohyoid membrane (TH) in the clinical trials of thyrohyoid membrane (TH) for intra LCG injection of hormone. Application value.3. to study the clinical effect of simple proton pump inhibitor (proton pump inhibitor, PPI), LCG internal hormone injection combined with PPI suppressor therapy in the treatment of LCG, method 1. continuous collection of 42 cases of LCG patients' laryngeal HRCT thin layer scan images from May 2015 to September 2016, and a continuous retrospective statistical treatment of the laryngeal HRCT before treatment. Imaging images of 50 cases of laryngeal lesions (vocal cords or leukoplakia) with thin layer scanning, and the analysis and comparison of the patients with LCG and their healthy side, the patients with larynx disease and the case of arytenoid hardening between the affected sides of the patients.2. retrospective analysis of the treatment of LCG in the TH path of the vocal corticosteroids from February 2013 to October 2015 The clinical data of 32 patients with 32 cases of injection success, tolerance and adverse reactions were tracked and recorded in 88 cases of LCG patients treated in our department from March 2010 to October 2014, 67 cases of LCG patients treated with simple anti acid therapy were taken as control group, and the same period in our department was treated with LCG injection combined with anti acid treatment. In the 1. imaging study, the average age (48.3 + 9.6), 28 sides of the left vocal cord, 13 sides of the right side, bilateral involvement in 1, and the 50 cases of the larynx group, the average age (61.2 + 9.9), the left vocal cord involvement on the 13 side, and the 42 side of the right side in the 42 LCG patients. Bilateral involvement in 11 cases; the affected side of the patients with LCG, the healthy side, and the larynx disease group were 79.07% (34/43), 7.32% (3/41), 13.11% (8/61) under the healthy side, respectively, and 13.11% (8/61). 2.56% (1/39).LCG patients were significantly more sclerosis than the healthy side and laryngeal lesions (p1,2,3=0.0), and the difference was statistically significant (p1,2,3=0.0). 00): in group LCG, there was no significant difference in age and non sclerosis in patients with diplike cartilage (p=0.209) in.2.32 patients, 34 side lesions in.2.32 patients, 113 times by TH method, and 3 times per patient, each injection was 0.3 to 1.0mg, and the success rate of one injection was 100%. During the follow-up period of the 26 month follow-up period, 67 cases of LCG patients who had no severe complications.3. were cured, 50 cases (74.63%) were cured, the average cure time was (5.31 + 0.38) months, the total effective rate was 97.01%. In the 21 patients with LCG injection combined with acid suppressor therapy, 15 cases (71.43%) were cured, the average cure time (3.80 + 0.43) months, total effective 95.24%; The cure rate of the group was not statistically significant (X2=0.085, p=0.771), but the cure time of the hormone injection group was shorter than that of the control group (Z=-2.093, p=0.036). Conclusion the HRCT hardening rate of the cricoarytenoid cartilage in the patients with 1.LCG was 79.07%, and had no obvious correlation with the age. It could be used as an imaging manifestation of the disease, and the appearance of this phenomenon may be associated with the lesion site. Long term, repeated inflammatory stimulation of.2. through TH method of vocal cord injection for the treatment of LCG field of vision, accurate operation, high success rate, patient more tolerable, less adverse reactions, it is worth popularizing.3. simple acid suppressor therapy with internal hormone injection combined with anti acid therapy for LCG treatment is equivalent, and the treatment effect is significant, the latter can shorten the cure time.

【学位授予单位】：南方医科大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R767.91

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