| ?Objective?To analyze the clinical characteristics and the morphological characteristics in laryngoscopy of vocal cord leukoplakia,and to compare their relationship with pathological characteristics.To conduct the preliminary classification and explore the influencing factors of high-risk pathologic types,In order to improve the accuracy of primary diagnosis of the nature of leukoplakia before treatment,and provide the evidence for making therapeutic schedule.?Methods?The clinical data of 187 patients with vocal cord leukoplakia were recruited in the retrospective study,who were inpatients at the Department ofOtorhinolaryngology Head and Neck Surgery in Fujian Provincial Hospital from January 2008 to December 2016.To estimate the morphology of leukoplakia in laryngoscope including size,thickness,bilateral,pre-combined,etc.According to the size,thickness and surface conditions,classified them to three types: type?(small + thin + homogeneous),type?(large + thin + homogeneous,small + thick + homogeneous,small + thin + heterogeneous),type(large + thick + homogeneous,small + thick + ?heterogeneous,large + thin + heterogeneous,large + thick + heterogeneous).The patient's postoperative pathology is divided into four categories:Nondysplasia,Mild squamous dysplasia,Moderate squamous dysplasia and Severe squamous dysplasia(or carcinoma),and according the pathology,the patients further divided into high risk group and low risk group.Descriptive statistics were calculated for baseline subject characteristics,and the results are reported with mean±standard deviation.And the indicators of the pathology-related group were analyzed by single factor analysis.The ?2 test or the Fisher exact probability method,t-test,Rank sum test,Spearman nonparametric correlation test and Logistic regression model were used to investigate the indexes.Two-sided P values <.05 were considered statistically significant.All calculations were performed with SPSS software(version 19.0).?Result?1.There were 179 males(95.7%)and 8 females(4.3%)enrolled,male to femal?22.4:1;The age span of the patients in this study was 27 to 79 years,the mean age was 51.8±10.5 years.28 patients(15.0%)were less than or equal to 40 years old,125 patients(66.8%)were 40 to 60 years old,and 34 patients(18.2%)were over 60 years old.There were 105 smokers in this study.Hoarseness is the main symptoms in 159 patients(85.0%).2.There were 93 patients(49.7%)of type?,59 patients(31.6%)of type and ?35 patients(18.7%)of type ?;3.There were 83 patients(44.4%)of Nondysplasia,56 patients(29.9%)of Mild squamous dysplasia,27 patients(14.4%)of Moderate squamous dysplasia and 21 patients(11.2%)of Severe squamous dysplasia(or carcinoma).4.The pathology of 97 sides(63.8%)in type?were Nondysplasia;The pathology of 54 sides(73.0%)in type?were Mild or Moderate squamous dysplasia;The pathology of 33 sides(73.3%)in type?were Moderate squamous dysplasia or Severe squamous dysplasia(or carcinoma);The difference of the laryngoscope classifications in pathology was statistically significant(P=0.000).There was a positive correlation with the degree of dysplasia and laryngoscope classifications(r = 0.506,P <0.01).5.There were statistically significant difference in the pathological categories between the large and the small(P=0.000),the thick and the thin(P=0.001),the homogeneous and the heterogeneous(P=0.000),the pre-combined and the none(P=0.001),the benign complication of other side and the none(P=0.033).The incidence rate of squamous dysplasia in the morphology of leukoplakia was significantly different : the large(26/34,76.47%)was more than the small(78/153,50.98%);the thick(44/64,68.75%)was more than the thin(60/123,48.78%);the heterogeneous(38/41,92.68%)was more than the homogeneous(66/146,45.21%);the pre-combined(11/12,91.67%)was more than the none(93/171,45.21%);the benign complication of other side(9/22,40.91%)was less than the none(95/165,51.57%).6.According to the potential dangers of pathologic dysplasia,we divided all patients into the low-risk group or high-risk group.The low-risk group included nondysplasia,mild and moderate squamous dysplasia,total 166 patients(88.8%).And there were 21patients(11.2%)in the high-risk group.The diference of the age between the low-risk group and high-risk group was statistically significant(P=0.03).The mean age(59.43±9.1)in the high-risk group was significantly higher than that in the low-risk group(50.83±10.3).The morphological classification of leukoplakia(OR = 8.964,P = 0.000)and the pre-combined(OR=24.929,P=0.000)were the independent influencing factors of high-risk pathological categories.?Conclusion?1.The patients of Vocal cord leukoplakia are mainly male and smokers.And the age rank of patients is mainly 40 to 60.There are correlations between age and pathological categories,suggesting that elderly patients is more likely with high-risk pathological types.2.The pathology of Vocal cord leukoplakia is mainly Nondysplasia.The higher level of the laryngoscope classification suggests the higher grade of squamous dysplasia.And the morphological classification of leukoplakia and the pre-combined are the independent influencing factors of high-risk pathological categories.3.For the patients of vocal cord leukoplakia,we can combine laryngoscopic morphological classification,the condition of the the pre-combined,the patient's age and so on to comprehensively evaluate the nature of leukoplakia,and make the reasonable treatment programs. |
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