Clinical classification and management of squamous intraepithelial lesions of the vocal cord
10.3760/cma.j.issn.1673-0860.2012.08.010
- VernacularTitle:声带黏膜上皮病变的临床特征与治疗
- Author:
Li-Jing MA
1
;
Jun WANG
;
Jing-Ying YE
;
Wen XU
;
Qing-Wen YANG
Author Information
1. 首都医科大学附属北京同仁医院
- Keywords:
Vocal cords;
Laryngeal mucosa;
Leukoplakia;
Keratosis;
Hyperplasia;
Laser therapy
- From:
Chinese Journal of Otorhinolaryngology Head and Neck Surgery
2012;47(8):657-661
- CountryChina
- Language:Chinese
-
Abstract:
Objective To discuss the clinical classification of the squamous intraepithelial lesions (SILs) of vocal cord and their outcomes after different therapeutic procedures.Methods Three hundred and forty-three patients with the SILs of vocal cord were enrolled.Based on the history of the diseases,macroscopic appearance by video rhinolaryngoscopic,stroboscopic and microlaryngocopic examination,and pathological findings,the correlation of clinical features,treatment modalities and treatment effect of the vocal cord SILs were discussed.Results According to the morphological characteristics,343 patients were divided into four types.Type Ⅰ,leukoplakia combined with inflammation ( n =19 ) ; type Ⅱ,leukoplakia combined with polyps by friction ( n =72 ) ; type Ⅲ,leukoplakia combined with sulcus vocalis ( n =64 ) ;type Ⅳ,keratosis (n =188 ).Patients with type Ⅰ lesions were treated by medications.The vocal cord configuration and the voice of the patients in type Ⅰ returned to normal after treatment.Patients with type Ⅱ,Ⅲ,Ⅳ lesions were treated by CO2 laser.Type Ⅱ were treated by subepithelial cordectomy,type Ⅲ by mucosa slicing with dredging,type Ⅳ by subligament cordectomy or transmuscular cordectomy.The cure rate of patients with type Ⅱ,Ⅲ,Ⅳ lesions was 90.7％ (294/324) after single surgery,the recurrent rate was 9.3％ (30/324).Twenty-one patients( 11.2％ ),all in type Ⅳ,developed carcinogenesis.Eight cases were diagnosed in the first surgery and 13 cases in the second.Among the 13 cases diagnosed in the second surgery,2 cases had partial laryngectomy for the third surgery.Conclusions Since the squamous intraepithelial lesions of vocal cord manifested differently,conservative treatment or CO2 laser surgery should be used.In this way,a less invasive procedure,better recovery of the voice and less complication could be expected.
