Dedo H H, Yu K C
Department of Otolaryngology-Head and Neck Surgery, University of California, San Francisco, San Francisco, California 94117, USA.
Laryngoscope. 2001 Sep;111(9):1639-44. doi: 10.1097/00005537-200109000-00028.
Respiratory papillomas (RP) tend to recur and the difficulty in eradicating the disease makes their treatment frustrating. Meticulous CO(2) laser excisions every 2 months has been the most effective treatment to date. This article analyzes the results of this plan in 244 patients with RP in the nose, nasopharynx, pharynx, hypopharynx, larynx, trachea, lung parenchyma, and skin.
Two hundred forty-four patients with recurrent RP were treated by the senior author with CO(2) laser excisions and, in some cases, podophyllum and alpha interferon. Demographics, initial distribution of papillomas, number of operations performed on each patient, and current results were evaluated.
Careful laser excisions of RPs every 2 months achieved "remission" of disease (no visible RP on indirect or often direct laryngoscopy 2 mo after last removal) in 37% of patients, "clearance" of the disease process (no RP clinically apparent for 3 y after last removal) in 6%, and "cure" (no clinical recurrence for 5 y after last removal) in 17%. Juvenile-onset RP tends to follow a more aggressive course than adult-onset RP. Four patients (1.6%) developed malignant transformation of their papillomas. Except for ones in lung parenchyma, RP in areas other than the true vocal cords tend to be cleared faster because aggressive removal does not cause hoarseness. Lung parenchyma RPs are eventually fatal because of pulmonary failure from abscesses and cysts resulting from a lack of effective treatment.
Frequent and meticulously performed CO(2) laser excisions can achieve significant voice and airway improvement, and some clinical "cures." However, effective antiviral medicines and/or immunologic agents are needed to achieve true cures with elimination of all human papilloma virus 6 and 11 viruses.
呼吸道乳头状瘤（RP）易于复发，且难以根除，这使得其治疗令人沮丧。迄今为止，每2个月进行一次细致的二氧化碳激光切除术是最有效的治疗方法。本文分析了该方案对244例鼻腔、鼻咽、咽、下咽、喉、气管、肺实质和皮肤RP患者的治疗结果。
资深作者采用二氧化碳激光切除术治疗244例复发性RP患者，部分病例联合使用鬼臼毒素和α干扰素。评估了患者的人口统计学资料、乳头状瘤的初始分布、每位患者的手术次数以及当前治疗结果。
每2个月对RP进行仔细的激光切除，使37%的患者疾病“缓解”（最后一次切除后2个月间接喉镜或常为直接喉镜检查未见可见的RP），6%的患者疾病进程“清除”（最后一次切除后3年临床上无明显RP），17%的患者“治愈”（最后一次切除后5年无临床复发）。青少年期发病的RP往往比成年期发病的RP病程更具侵袭性。4例患者（1.6%）发生乳头状瘤恶变。除肺实质外，真声带以外区域的RP由于积极切除不会导致声音嘶哑，往往清除得更快。肺实质RP最终因缺乏有效治疗导致脓肿和囊肿引起呼吸衰竭而致命。
频繁且细致地进行二氧化碳激光切除可显著改善声音和气道状况，并实现一些临床“治愈”。然而，需要有效的抗病毒药物和/或免疫制剂来实现真正的治愈，即清除所有6型和11型人乳头瘤病毒。
