Kashima H K, Kessis T, Mounts P, Shah K
Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins Medical Institutions, Baltimore, MD 21205.
Otolaryngol Head Neck Surg. 1991 Feb;104(2):191-5. doi: 10.1177/019459989110400206.
Human papillomavirus (HPV) DNA was identified in the plume produced during CO2 laser vaporization of respiratory tract papillomata. The plume produced from CO2 vaporization was collected on Gelfoam pledgets that were affixed to suction tips evacuating the vapor plume from the operative field. The Gelfoam pledgets were snap frozen in liquid nitrogen, processed, and examined for HPV-6 and HPV-11 DNA by a polymerase chain reaction technique. Tissue and vapor-plume specimens were collected from 22 patients undergoing CO2 laser excision of laryngeal lesions. Seven patients had adult-onset recurrent respiratory laryngeal papillomatosis (RRP), 12 had juvenile-onset RRP, two had laryngeal carcinoma, and one had nonspecific laryngitis. HPV-6 or HPV-11 was identified in 17 of 27 vapor-plume specimens from RRP and in none of three from non-RRP lesions. All but one RRP tissue specimen contained HPV-DNA, and none of the non-RRP tissues contained HPV-DNA. When HPV was present in vapor, the same HPV type was found in the corresponding tissue specimen. Identification of HPV-DNA in the laser plume raises concern regarding potential risks from exposure to the plume--particularly to the endoscopic surgeon and the operating team. The practical concerns and effectiveness of the plume scavenging systems are discussed.
在二氧化碳激光汽化呼吸道乳头瘤过程中产生的烟雾中发现了人乳头瘤病毒（HPV）DNA。二氧化碳汽化产生的烟雾收集在明胶海绵小块上，这些小块固定在从手术区域抽出烟雾的吸引头上。将明胶海绵小块在液氮中速冻、处理，并用聚合酶链反应技术检测HPV - 6和HPV - 11 DNA。从22例接受二氧化碳激光切除喉部病变的患者中收集组织和烟雾标本。7例患有成人复发性呼吸道喉乳头瘤病（RRP），12例患有青少年型RRP，2例患有喉癌，1例患有非特异性喉炎。在RRP的27个烟雾标本中的17个中鉴定出HPV - 6或HPV - 11，而在非RRP病变的3个标本中均未鉴定出。除1个RRP组织标本外，所有RRP组织标本均含有HPV - DNA，非RRP组织均不含HPV - DNA。当烟雾中存在HPV时，在相应的组织标本中发现相同类型的HPV。在激光烟雾中鉴定出HPV - DNA引发了对暴露于烟雾潜在风险的担忧，尤其是对内窥镜外科医生和手术团队而言。讨论了烟雾清除系统的实际问题和有效性。
