喉的急慢性炎症---副本.ppt

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style,耳鼻咽喉头颈外科学,耳鼻咽喉头颈外科学,第三篇,喉科学（,2,）,第八章,喉的慢性非特异性炎症,第一节,慢性喉炎,慢性喉炎,慢性喉炎是指喉部慢性非特异性炎症，临床上可分为慢性单纯性喉炎、肥厚性喉炎、和萎缩性喉炎,1,.,用声过度,2,.,长期吸入有害气体或粉尘,3,.,鼻腔、鼻窦或咽部慢性炎症,4,.,急性喉炎长期反复发作或迁延不愈,5,.,下呼吸道有慢性炎症,病因,检查所见,慢性单纯性喉炎：,喉黏膜弥漫充血，声带呈粉红色，轻度肿胀，边缘变钝。声带表面有时可见黏痰，在两侧声带缘之间形成黏液丝。,肥厚性喉炎：,以室带肥厚多见，声带肥厚边缘变钝。,萎缩性喉炎：,喉黏膜变薄、干燥，严重者表面有痂皮形成。,长期声嘶的病史,喉镜检查所见,通常不难作出诊断,但引起声嘶的喉部疾病较多，应注意鉴别,诊断,1,.,去除病因,2,.,雾化吸入,3,.,中药,治疗,第二节,喉息肉,声带息肉,声带息肉好发于声带前中1/3交界处边缘，多为单侧，是引起声音嘶哑的常见疾病之一。,1.用声不当或用声过度,循环障碍-出血学说:声带剧烈振动血管破裂形成血肿血肿扩大致局部循环障碍继发性水肿、血管扩张伴有淋巴细胞浸润的炎症变化,病因,2.上呼吸道病变,感冒，急、慢性喉炎，鼻炎、鼻窦炎等可以是声带息肉发生的诱因,3,.,吸烟,可刺激声带，使血浆渗入任氏间隙,4,.,内分泌紊乱,多见于更年期妇女，可能与雌激素有关；甲状腺功能减退或亢进也有关系,5,.,变态反应,主要在黏膜固有层，弹力纤维和网状纤维破坏。表现为黏膜上皮下层有水肿、出血、血浆渗出、血管扩张、毛细血管增生、血栓形成、纤维蛋白物沉着，黏液样变性、玻璃样变性和纤维化等。,病理,上皮层,固有层（任克层、弹力纤维层、胶原纤维层）,肌肉层,声带显微结构,声带息肉多见于声带边缘前中1/3交界处,该处是膜部声带的中点，振动时振幅大而易受损伤；,该处存在振动结节，在其上皮下易产生血流静止与淤积；,该处血管分布与构造特殊，且该处声带肌上下方向交错，发声时出现捻转运动，血供发生复杂变化。,主要为声嘶，因息肉大小、部位和形态不同，声嘶程度不同。,轻者为间隙性声嘶，发高音困难,重者沙哑甚至失声,巨大息肉可致呼吸困难和喘鸣,息肉垂于声门下腔者常因刺激引起咳嗽,临床表现,可见声带游离缘前中1/3交界处见表面光滑、半透明新生物，形态、大小各异，多是灰白色或淡红色，一般单侧多见。,检查所见,检查所见,以手术切除为主，辅以糖皮质激素和抗生素等治疗。切除息肉应常规送病理检查。,治疗,声带息肉术前,声带息肉术后,第三节,声带小结,声带小结,声带小结是慢性喉炎的一种常见类型，由炎性病变形成。,长期用声过度或用声不当是本病的重要原因。,声带小结外观呈灰白色小隆起，病理改变主要在上皮层。黏膜上皮局限性棘细胞增生，上皮表层角化过度或不完全角化，继发纤维组织增生、透明样变性，基底细胞生长活跃，上皮角延长、增宽。,病理,早期主要为发声易倦和间隙性声嘶，声嘶于发高音时出现。,病情发展时声嘶加重，由沙变哑，由间隙性变持续性。,临床表现,双侧声带前中1/3交界处边缘对称性结节状隆起，发声时声门不能完全闭合。,检查所见,1,.,禁声休息,2,.,保守治疗无效者可行手术切除,治疗,声带白斑,喉黏膜上皮细胞片状过度角化增生，呈现厚的白色病变。,多见于声带，是癌前病变。,病理变化为喉黏膜上皮不典型增生。,可能与吸烟、用声不当、慢性喉炎及维生素或微量元素缺乏等有关。,主要症状是声嘶,喉镜检查见声带表面或边缘有表面平整的白色斑片状隆起，范围局限、声带运动正常。,采取支撑喉镜和显微镜下声带剥皮术,定期复查,治疗,Thank You!,