Clinical Evolution of Laryngeal Granulomas: Treatment and Prognosis
Clinical Evolution of Laryngeal Granulomas: Treatment and Prognosis
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喉肉芽肿的临床演变：治疗和预后
DOI：
10.1097/00005537-199902000-00021
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发表时间：
1999
期刊：
影响因子：
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通讯作者：
M. E. Gadelha
中科院分区：
文献类型：
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作者：
P. De Lima Pontes;N. D. de Biase;M. E. Gadelha
目的/假设：探讨与手术无关的肉芽肿患者的治疗反应。方法：回顾分析1996年6月在巴西圣保罗S拉林格研究所收治的66例喉肉芽肿病例，其中胃食道反流综合征20例(303%)，发声障碍22例(33.3%)，气管插管后15例(22.7%)，特发性9例(13.6%)。结果：在确诊的66名患者中，有10名没有开始治疗，只有56名患者进行了分析，其中6人后来放弃了治疗。针对病因的治疗对插管后肉芽肿的控制率为100%。在反流和发声虐待的病例中，仅考虑病因时的成功率分别为75%和87.5%。在原因不明的病例中，所有患者都接受了手术切除，无论是否进行临床或语音治疗；我们在第一次试验中仅获得了37.5%的成功率。其中，经过各种不成功的抢救治疗，其中3例经A型肉毒毒素治疗后100%痊愈。不同原因复发率不同，插管后无复发率，反流性食管炎复发率为21.4%，发声障碍复发率为35.2%，特发性复发率为62.5%。结论：喉部肉芽肿以插管后预后最好，原因不明预后最差。那些归因于胃食道反流和发声虐待的病例有很高的解决率，尽管有些病例需要抢救程序。
Objective/Hypothesis: To study the response to treatment by patients with granulomas not related to surgery, considering their respective causes. Methods: Retrospective study of larynx granulomas seen at the Institute da Laringe (Sǎo Paulo, Brazil) from June 1996, totaling 66 patients, being 20 (30,3%) diagnosed with gastroesophageal reflux syndrome, 22 (33,3%) due to vocal abuse, 15 (22,7%) to postorotracheal intubation, and 9 (13,6%) of idiopathic cause. Findings: Of the 66 patients diagnosed, 10 did not start the treatment, with only 56 being analyzed, 6 of whom later abandoned the treatment. The cause‐oriented treatment showed 100% control in postintubation granulomas. In the cases of reflux and vocal abuse, the success rates when considering only the cause were 75% and 87.5%, respectively. In the cases of undefined cause, all were subjected to surgical removal with or without clinical or speech‐therapy treatment; we attained only a 37.5% success rate in the first trial. Of these, after various unsuccessful rescue treatments, three which were treated with botulinum toxin type A had 100% resolution. The recurrence percentage varied according to the cause, being nonexistent in the postintubation cases, 21.4% in patients with reflux esophagitis, 35.2% in vocal abuse, and 62.5% in those of idiopathic etiology. Conclusion: Of the laryngeal granulomas, the best prognoses were given by the postintubation ones, whereas the worst were those of undefined cause. Those ascribed to gastroesophageal reflux and vocal abuse have a high resolution rate, although some cases need rescue procedures.