聲帶突肉芽腫

聲帶突肉芽腫(vocal process granuloma)發生在聲門後側聲帶突之上，外觀狀似潰瘍與傷口癒合期常見之局部肉芽組織，臨床上或用其他名稱如接觸性潰瘍/肉芽(contact ulcer/granuloma)、插管性潰瘍/肉芽(intubation ulcer/granuloma)等稱之。常見之症狀包括咽喉異物感、慢性咳嗽，嗓音變化與少數呼吸道窘迫之症狀則視病灶大小與位置而定。在病因上可分成發炎性(inflammatory)與物理性(mechanical)傷害兩大範疇；物理性外傷常見於氣管內插管後，相關因子包括氣管內管留置時間長、管徑大、插管視野不明、手術中移動頭部(頸部)、或麻醉深度控制不當等。此外，音聲過度使用或習慣性清喉嚨也可能造成雙側杓狀軟骨互相碰撞進而形成肉芽腫。慢性炎症如胃食道逆流，常見於生活飲食習慣不良(如暴飲暴食、宵夜、飲酒等)之患者。除了胃液外，呼吸道過敏或鼻涕逆流也可能間接透過患者反覆清喉嚨的動作而造成聲帶突肉芽腫或潰瘍。聲帶突肉芽腫在治療上首重病患衛教並調整生活型態，近年研究即指出約8成病患之肉芽腫於追蹤30周後可完全消失或症狀緩解。對於用聲習慣不良之患者可透過嗓音治療減輕聲門過度接觸，針對胃食道逆流之個案，可給予治酸劑或氫離子阻斷劑，療程約需4-6個月。部分頑固難治之個案，則可嘗試其他替代性療法如病灶內施打類固醇，控制局部炎症反應；或於甲杓肌施打肉毒桿菌素，減少雙側聲帶過度碰撞，唯病患必須忍受治療後數月間發聲不適及音量減小。外科手術切除雖可一次性移除贅生物，但因手術過程中可能連帶造成聲帶突周遭黏膜或軟骨傷害，術後之復發率甚高，可考慮保留至病患出現呼吸道窘迫或診斷不明需病理化驗之情形下施行。

關鍵字

咽喉；潰瘍；氣管內插管；胃食道逆流；氫離子阻斷劑

並列摘要

Vocal process granuloma (VPG) is a benign exophytic mass lesion originating from the vocal process of the arytenoid cartilage, which reflects an ongoing healing process from chronic trauma and irritation to the mucosa and perichondrium. Other synonyms of VPG include contact ulcer/granuloma, and intubation ulcer/granuloma. VPG frequently present with lumping sensation of throat, mild dysphonia, chronic cough, and rarely, respiratory distress. The common contributing factors to VPG include gastroesophageal reflux and abusive vocal behaviors (e.g. low-pitch speech, throat clearing). Intubationrelated trauma are more likely to cause VPG on the following conditions: prolonged intubation, large tube diameter, blind intubation, and movement of tube or the patient intra-operatively, whereas reflux are more frequently among patients with inadequate life and diet habits. Most clinicians agree that conservative treatment is the first choice for managing vocal process granuloma, mainly due to the high chance of spontaneous resolution (80% within 30 weeks). Anti-reflux medication, such as proton pump inhibitors for 4 to 6 months, is another common adjuvant therapy. In refractory cases, intralesional steroid injection or botulinum toxin injection can be performed alternatively. Although surgical excision completely remove the lesion at once, surgery itself creates a new (larger) wound, which explain the high recurrence rates post-operatively. Herein, surgery can be reserved for questionable cases who requires proof from histopathology, or cases present with respiratory distress.

並列關鍵字

larynx ； ulcer ； endotracheal intubation ； gastroesophageal reflux ； proton pump inhibitor

國際替代計量

聲帶突肉芽腫

全文下載

主題瀏覽