本文選題：聲帶白斑　切入點(diǎn)：復(fù)發(fā)　出處：《浙江大學(xué)》2017年碩士論文　論文類(lèi)型：學(xué)位論文

【摘要】：目的分析影響聲帶白斑術(shù)后復(fù)發(fā)、癌變的相關(guān)預(yù)后因素。方法回顧性分析于1998年1月～2013年12月期間在本院首次手術(shù)治療的416例聲帶白斑患者的臨床資料,采用Kaplan-Meier法計(jì)算術(shù)后1、3、5年復(fù)發(fā)率和癌變率,并用采用Log-Rank法分析性別、年齡、病程、吸煙、酗酒、白斑范圍、累及前連合、手術(shù)方式、組織病理與聲帶白斑術(shù)后復(fù)發(fā)、癌變的關(guān)系,篩選與術(shù)后復(fù)發(fā)、癌變相關(guān)的變量,進(jìn)入COX多因素回歸模型分析,計(jì)算這些因素的相對(duì)風(fēng)險(xiǎn)比(Hazard ratio,HR)。結(jié)果416例聲帶白斑患者中,107例術(shù)后復(fù)發(fā),43例術(shù)后癌變,1、3、5年復(fù)發(fā)率分別為 9.4%、19.9%、24.3%,1、3、5 年癌變率分別為 1.9%、6.3%、9.3%。復(fù)發(fā)相關(guān)的單因素分析結(jié)果顯示:年齡,病程,白斑范圍,累及前連合,手術(shù)方式,組織病理這六項(xiàng)因素與聲帶白斑術(shù)后復(fù)發(fā)相關(guān)。將這些因素進(jìn)入術(shù)后復(fù)發(fā)COX多因素回歸模型分析,得出白斑范圍,累及前連合,手術(shù)方式,組織病理是影響聲帶白斑術(shù)后復(fù)發(fā)的預(yù)后因素,而年齡,病程不是影響聲帶白斑術(shù)后復(fù)發(fā)的預(yù)后因素。白斑范圍≥1/2組的術(shù)后復(fù)發(fā)風(fēng)險(xiǎn)是1/2組的1.73倍;白斑累及前連合組的術(shù)后復(fù)發(fā)風(fēng)險(xiǎn)是未累及前連合組的2.19倍。支撐喉鏡顯微鏡下CO2激光手術(shù)組的術(shù)后復(fù)發(fā)風(fēng)險(xiǎn)是支撐喉鏡顯微鏡下聲帶黏膜剝脫術(shù)組的0.34倍。中度異型增生組的術(shù)后復(fù)發(fā)風(fēng)險(xiǎn)是鱗狀上皮增生組的2.58倍,而重度異型增生組的術(shù)后復(fù)發(fā)風(fēng)險(xiǎn)是鱗狀上皮增生組的5.80倍。癌變相關(guān)的單因素分析結(jié)果顯示:年齡,白斑范圍,累及前連合,組織病理四項(xiàng)因素與聲帶白斑術(shù)后癌變相關(guān)。將這些因素進(jìn)入術(shù)后癌變COX多因素回歸模型分析,得出累及前連合,組織病理是影響聲帶白斑術(shù)后癌變的預(yù)后因素,而年齡,白斑范圍不是影響聲帶白斑術(shù)后癌變的預(yù)后因素。白斑累及前連合組的術(shù)后癌變風(fēng)險(xiǎn)是未累及前連合組的3.05倍。輕度異型增生組的術(shù)后癌變風(fēng)險(xiǎn)是鱗狀上皮增生組的3.51倍,中度異型增生組的術(shù)后癌變風(fēng)險(xiǎn)是鱗狀上皮增生組的16.92倍,重度異型增生組的術(shù)后癌變風(fēng)險(xiǎn)是鱗狀上皮增生組的44.24倍。結(jié)論:白斑范圍,累及前連合,手術(shù)方式,組織病理是影響聲帶白斑術(shù)后復(fù)發(fā)的預(yù)后因素;白斑的范圍越廣,聲帶白斑術(shù)后復(fù)發(fā)風(fēng)險(xiǎn)越高;白斑累及前連合,聲帶白斑術(shù)后的復(fù)發(fā)風(fēng)險(xiǎn)高;白斑的組織病理分級(jí)越高,聲帶白斑術(shù)后復(fù)發(fā)風(fēng)險(xiǎn)越高。累及前連合,組織病理是影響聲帶白斑術(shù)后癌變的預(yù)后因素;白斑累及前連合,聲帶白斑術(shù)后癌變風(fēng)險(xiǎn)高;白斑的組織病理分級(jí)越高,聲帶白斑術(shù)后癌變風(fēng)險(xiǎn)越高。
[Abstract]:Objective to analyze the effect of postoperative recurrence of leukoplakia and related prognostic factors of cancer. Methods a retrospective analysis from January 1998 to December 2013 in our hospital for the first time during the surgical treatment of 416 cases of vocal cord leukoplakia in patients with clinical data, calculate the postoperative 1,3,5 recurrence rate and canceration rate by Kaplan-Meier method, and Log-Rank method was used to analyze gender, age. The course of disease, smoking, alcoholism, leukoplakia, anterior commissure involvement, surgery, tissue pathology and postoperative recurrence of leukoplakia canceration, the relationship between screening and postoperative recurrence of cancer related variables into the COX regression model analysis, calculate the relative risk of these factors than (Hazard ratio, HR). Results 416 cases of vocal cord leukoplakia, 107 cases of postoperative recurrence, 43 cases of canceration of postoperative 1,3,5 recurrence rates were 9.4%, 19.9%, 24.3%, 1,3,5 years canceration rate were 1.9%, 6.3%, and single factor analysis of recurrence of 9.3%. related The results show that the age, course of disease, leukoplakia, anterior commissure involvement, surgery, pathology of the six factors and vocal leukoplakia postoperative recurrence and related. These factors enter the multi factors of recurrence after COX regression analysis, the white spot area, anterior commissure involvement, surgery, pathology were prognostic factors. The postoperative recurrence of vocal cord leukoplakia and age, prognostic factors of recurrence of leukoplakia postoperative course is not affected. The white spots above 1/2 group the recurrence risk is 1.73 times higher than that of 1/2 group; leukoplakia involving the anterior commissure group the postoperative recurrence risk is 2.19 times without involvement of the anterior commissure laryngoscope under the microscope group. CO2 laser the surgery group the recurrence risk is the laryngoscope under the microscope to peel off vocal mucosa 0.34 times surgery group. Moderate dysplasia group of postoperative recurrence risk is 2.58 times of squamous epithelial hyperplasia group, and severe dysplasia group postoperative rehabilitation The risk is 5.80 times of squamous epithelial hyperplasia group. Cancer related results of univariate analysis showed that age, white spots, the anterior commissure involvement, pathological factors and four postoperative vocal cord Leukoplakia Carcinogenesis related. These factors will enter cancer after multi factor COX regression model analysis, the anterior commissure involvement is pathology the factors affected the prognosis of cancer, postoperative vocal cord leukoplakia and the age range is not affected, leukoplakia of vocal cord leukoplakia canceration. Postoperative prognostic factors of leukoplakia involving the anterior commissure of postoperative cancer risk is 3.05 times without involvement of the anterior commissure group. Mild heterotypic hyperplasia group of postoperative cancer risk is 3.51 times of squamous epithelial hyperplasia group. Moderate dysplasia group of postoperative cancer risk is 16.92 times of squamous epithelial hyperplasia group, severe dysplasia group postoperative cancer risk is 44.24 times of squamous epithelial hyperplasia group. Conclusion: the white spots, even involving the former Combined surgery, pathology were prognostic factors for recurrence after resection of vocal cord leukoplakia leukoplakia; range more widely, leukoplakia recurrence risk is higher; leukoplakia involving the anterior commissure, the risk of postoperative recurrence of vocal cord leukoplakia leukoplakia; pathological grade is higher, the vocal cords of white spot recurrence risk is higher involving the anterior commissure. Histopathology, were prognostic factors for postoperative cancer leukoplakia; leukoplakia involving the anterior commissure, leukoplakia postoperative cancer risk; histopathological grading leukoplakia is higher, postoperative vocal cord leukoplakia cancer risk is higher.

【學(xué)位授予單位】：浙江大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2017
【分類(lèi)號(hào)】：R767.91
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本文編號(hào)：1613244