Department of Otolaryngology, University of Nigeria Teaching Hospital, Enugu, Nigeria.
World J Surg. 2013 Feb;37(2):339-43. doi: 10.1007/s00268-012-1839-y.
The frequent relapses of recurrent respiratory papillomatosis (RRP) sometimes demand repeated surgical excision with tracheostomy. This situation plays a vital role in the management of RRP in developing countries such as ours because of late presentation. This study was conducted to evaluate our experience with RRP and to determine the incidence and impact of tracheostomy in the overall management and outcomes of our patients.
The records of 59 patients with histologically confirmed RRP treated between 1994 and 2008 at our tertiary institution were reviewed. We collected data such as age at onset, tracheostomy frequency and duration, number of required surgical excisions, papilloma spread to the lower airways. Patients' characteristics and the course of the disease were compared between a juvenile-onset papillomatosis (JoRRP) group and an adult-onset group (AdRRP).
Overall, 68 % of our patients were in the JoRRP group (ages 2-11 years, mean 6 years). The other 32 % were 22-58 years of age (AdRRP group). Two cases of JoRRP continued into adult life. Multiple RRP dominated in the JoRRP group (93 %), whereas solitary papillomas predominated in the AdRRP group (63 %). Tracheostomy was performed because of upper airway obstruction in 42 % of our patients, with children accounting for 72 %. The mean duration of tracheostomy was 3.5 months, with 80 % lasting <4 months. Significantly more JoRRP patients had severe upper airway obstruction, required tracheostomy, and underwent multiple surgical excisions (p = 0.04, 0.02, and 0.009, respectively). Tracheobronchial spread occurred in a patient with prolonged tracheostomy.
Multiple laryngeal papillomatosis clearly followed a more severe and less predictable course than the solitary type in both groups. Although there was a high incidence of tracheostomy in this study, short-duration tracheostomies accounted for the low incidence of extralaryngeal spread.
复发性呼吸道乳头瘤病（RRP）的频繁复发有时需要反复手术切除并进行气管切开术。这种情况在我们这样的发展中国家的 RRP 管理中起着至关重要的作用，因为常常延误诊断。本研究旨在评估我们在 RRP 方面的经验，并确定气管切开术在我们患者的整体管理和结果中的发生率和影响。
对 1994 年至 2008 年在我们的三级机构治疗的 59 例经组织学证实的 RRP 患者的记录进行了回顾性分析。我们收集了发病年龄、气管切开术的频率和持续时间、所需手术切除次数、乳头状瘤向下呼吸道扩散等数据。比较了青少年发病型 RRP（JoRRP）组和成人发病型组（AdRRP）的患者特征和疾病过程。
总体而言，我们的患者中有 68%（2-11 岁，平均 6 岁）为 JoRRP 组。其余 32%（22-58 岁）为 AdRRP 组。2 例 JoRRP 持续到成年期。多发性 RRP 在 JoRRP 组中占主导地位（93%），而孤立性乳头状瘤在 AdRRP 组中占主导地位（63%）。由于上呼吸道阻塞，我们的 42%的患者需要进行气管切开术，其中儿童占 72%。气管切开术的平均持续时间为 3.5 个月，80%的患者持续时间<4 个月。JoRRP 患者中明显有更多的严重上呼吸道阻塞、需要气管切开术和多次手术切除（p=0.04、0.02 和 0.009）。在一名气管切开时间延长的患者中，发生了气管支气管扩散。
在两组中，多发性喉乳头状瘤的发病明显比单发类型更严重，且更具不可预测性。尽管本研究中气管切开术的发生率较高，但短时间气管切开术导致了喉外扩散的发生率较低。
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