本文選題：喉接觸性肉芽腫 + 抑酸療法��； 參考：《南方醫(yī)科大學(xué)》2017年碩士論文

【摘要】：目的目前關(guān)于喉接觸性肉芽腫(laryngeal contact granuloma,LCG)的機(jī)制和治療相關(guān)研究屢見不鮮,但是研究結(jié)果并不統(tǒng)一,為了進(jìn)一步探究該病的影響因素和有效的治療方法,我們對其進(jìn)行系列研究,擬達(dá)到以下目的:1.探討LCG患者患側(cè)杓狀軟骨高分辨率計(jì)算機(jī)體層X線攝影術(shù)(high-resolution computed tomography,HRCT)的影像學(xué)表現(xiàn),并與聲帶癌或聲帶白斑患者患側(cè)杓狀軟骨影像學(xué)進(jìn)行比較,探索該病的發(fā)病特點(diǎn)。2.初步探索經(jīng)甲狀舌骨膜(thyrohyoid membrane,TH)法行LCG內(nèi)激素注射的臨床應(yīng)用價值。3.探討單純質(zhì)子泵抑制劑(proton pump inhibitor,PPI)抑酸治療,LCG內(nèi)激素注射聯(lián)合PPI抑酸療法治療LCG的臨床效果。方法1.連續(xù)收集2015年5月～2016年9月42例LCG患者治療前喉部HRCT薄層掃描圖像,并連續(xù)回顧性統(tǒng)計(jì)治療前進(jìn)行過喉部HRCT薄層掃描的50例喉病變組(聲帶癌或聲帶白斑)患者影像學(xué)圖像,分析并比較LCG患者患側(cè)分別與其健側(cè)、喉病變組患者健、患側(cè)之間的杓狀軟骨硬化情況。2.回顧性分析2013年2月至2015年10月我科實(shí)施的經(jīng)TH徑路聲帶病變內(nèi)激素注射術(shù)治療LCG的32例患者臨床資料,對病人注射成功率、耐受性以及不良反應(yīng)等情況進(jìn)行跟蹤記錄。3.選取我科2010年3月～2014年10月診治的88例LCG患者,采取單純抑酸療法治療的67例LCG患者作為對照組,并選取同期在我科采取LCG內(nèi)激素注射聯(lián)合抑酸治療的21例患者作為試驗(yàn)組,對其治療效果進(jìn)行對照研究。結(jié)果1.影像學(xué)研究中,42例LCG患者中,平均年齡(48.3±9.6)歲,左側(cè)聲帶受累28側(cè),右側(cè)受累13側(cè),雙側(cè)受累1例;50例喉病變組患者中,平均年齡(61.2±9.9)歲,左側(cè)聲帶受累13側(cè),右側(cè)受累26側(cè),雙側(cè)受累11例;LCG患者患側(cè)、健側(cè)以及喉病變組患者患側(cè)、健側(cè)HRCT下杓狀軟骨硬化率分別為79.07%(34/43)、7.32%(3/41)、13.11%(8/61)、2.56%(1/39)。LCG 患者聲帶患側(cè)杓狀軟骨硬化現(xiàn)象顯著多于其健側(cè)和喉病變組健、患側(cè),差異均具有統(tǒng)計(jì)學(xué)意義(p1,2,3=0.000);LCG組患側(cè)杓狀軟骨硬化的患者年齡與非硬化的在統(tǒng)計(jì)學(xué)上無顯著差異(p=0.209)。2.32例患者中的34側(cè)病變,經(jīng)TH法LCG內(nèi)注射曲安奈德共計(jì)113次,每位患者中位注射次數(shù)3次,每次注射約0.3～1.0mg,一次注射成功率100%,患者配合良好,在中位隨訪時間26月的隨訪期內(nèi)未出現(xiàn)嚴(yán)重并發(fā)癥。3.單純抑酸治療的67例LCG患者中,治愈50例(74.63%),平均治愈時間(5.31 ±0.38)月,總有效率97.01%;LCG內(nèi)激素注射聯(lián)合抑酸治療的21例患者中,治愈15例(71.43%),平均治愈時間(3.80±0.43)月,總有效率95.24%;兩組的治愈率差異無統(tǒng)計(jì)學(xué)意義(X2=0.085,p=0.771),但激素注射組的治愈時間短于對照組(Z=-2.093,p=0.036)。結(jié)論1.LCG患者患側(cè)杓狀軟骨HRCT硬化率達(dá)79.07%,且與年齡無明顯相關(guān),可以作為該病的一項(xiàng)影像學(xué)表現(xiàn),同時此現(xiàn)象的出現(xiàn)可能與病變部位長期、反復(fù)受到炎性刺激有關(guān)。2.經(jīng)TH法聲帶注射術(shù)治療LCG視野開闊,操作準(zhǔn)確,成功率高,患者較易耐受,不良反應(yīng)少,值得推廣。3.單純抑酸療法與病變內(nèi)激素注射結(jié)合抑酸療法治療LCG療效相當(dāng),且治療效果顯著,后者可以縮短治愈時間。
[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.

【學(xué)位授予單位】：南方醫(yī)科大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2017
【分類號】：R767.91

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