Clinical Analysis Of 21 Cases Of Laryngeal Amyloidosis

Objective:To explore the clinical features and diagnosis and treatment of laryngeal amyloidosis.Methods:Retrospectively analyzed the clinical data of 21 patients diagnosed with laryngeal amyloidosis after surgical treatment and postoperative pathology admitted to the First Affiliated Hospital of Nanchang University from January 2009 to September 2019,including 12 men and 9 women.The age ranged from 15 to 64years,with an average age of 45.1 years.The onset time was 10 days to 13 years,with a median duration of 1 year.All patients underwent surgical treatment:18patients underwent general anesthesia under a supporting laryngoscope to remove the diseased tissue,of which 4 cases were CO₂ laser surgery;1 patient underwent outpatient laryngoscope underwent double vocal cord tumor biopsy,and the pathological diagnosis was laryngeal Amyloidosis,and was admitted to hospital for tracheotomy due to dyspnea;1 patient underwent general anesthesia under laryngeal splitting+T tube placement+tracheotomy,and the T tube was removed from our hospital 3 months after surgery.At this time,it was in a state of tracheotomy after tracheotomy.One year later,due to poor breathing during tube blockage,we came to our hospital for treatment and performed laryngeal dilatation;One patient underwent partial laryngectomy+tracheotomy+laryngeal function reconstruction under general anesthesia.All the diseased tissues removed after operation were examined by pathological hematoxylin-eosin staining.The homogeneous red staining material was deposited outside the cells.After further Congo red staining test,the pathological diagnosis was amyloidosis.Combined with relevant literature and clinical data of 21 patients with laryngeal amyloidosis,the clinical characteristics,diagnosis and treatment methods of laryngeal amyloidosis were discussed and summarized.Results:All 21 patients with laryngeal amyloidosis successfully completed the operation.Follow-up telephone follow-up from 6 months to 10 years,of which 6cases were lost to follow-up due to failure of contact information,the follow-up rate reached 71.4%.13 patients with hoarseness improved after operation.14 patients underwent laryngoscope surgery and recovered smoothly without recurrence.A patient diagnosed with laryngeal amyloidosis by outpatient pathological biopsy underwent tracheotomy due to dyspnea.One patient underwent partial laryngectomy+tracheotomy+laryngeal function reconstruction under general anesthesia,and began to block the tube after discharge.After 2 weeks,the hospital was reexamined and the tube was successfully extubated.One patient underwent general anesthesia under laryngeal splitting+T tube insertion+tracheotomy,and the T tube was pulled out in our hospital 3 months after surgery.One year later,he came to our hospital due to poor breathing when the tube was blocked.Perform laryngeal stenosis dilation.In one patient,the lesion was located before the vocal cord joint.A review of the video laryngoscope 2 weeks after the operation showed that the vocal cord joint was adhered,with slight hoarseness and no difficulty in breathing.One patient's reexamination of electronic laryngoscope after operation revealed a new organism in the operation area,and underwent surgical treatment under general anesthesia again.Postoperative pathology confirmed granulation tissue.Conclusion:Laryngeal amyloidosis is a rare clinical benign disease of the larynx.The clinical manifestation lacks specificity and is difficult to distinguish from other diseases.The laryngeal amyloid changes are mostly localized lesions,and under laryngoscope are mostly manifested as a single tumor-like substance,shaped like polyps,and the vocal cords are the most common site of disease.For clinical symptoms,the voice is mainly hoarse,Examination of the diseased tissue under laryngoscope showed a single tumor-like substance,light yellow nodules or extensive yellowish deposits under the mucosa.The possibility of laryngoamylosis should be highly suspected.The site of biopsy should be as deep as possible.The gold standard for laryngeal amyloidosis is positive Congo red staining.After the pathological examination confirms the diagnosis of laryngeal amyloidosis,the relevant examination should be completed first to exclude systemic amyloidosis of the whole body.At present,surgical treatment for the removal of laryngeal amyloid lesions is the preferred method of treatment.According to the clinical manifestations of the patients and the range of lesions shown in the examination,corresponding treatment plans are formulated.Patients with laryngeal amyloidosis should be followed up for a long time after surgical treatment.