Yang Q W, Xu W, Guo W, Cui W X, Li Y R, Wang X Y, Yang J, Li X Y
Department of Otorhinolaryngology Head and Neck Surgery, Beijing Tongren Hospital, Capital Medical University, Key Laboratory of Otorhinolaryngology Head and Neck Surgery(Capital Medical University), Ministry of Education of China, Beijing 100730, China.
Zhonghua Er Bi Yan Hou Tou Jing Wai Ke Za Zhi. 2017 Oct 7;52(10):733-737. doi: 10.3760/cma.j.issn.1673-0860.2017.10.004.
Juvenile on-set recurrent respiratory papillomatosis (JORRP) can be an aggressive and potentially life-threatening disease. To emphasize the importance of complication prevention in local excision surgery, the single-center experience of RRP treatment in a group of patients with relatively short recurrence-free-interval (>4 times/yrs) was reported. Data of 49 patients underwent papilloma resection during 2002-2013 were retrospectively analyzed. Combined techniques of laser microsurgery and microdebriders were used to remove papillomas, prevent the formation of scar tissue and improve respiratory distress. Forty-nine cases were followed up for 99.0[74.5; 121.0]months, ranging from 39 to 185 months. The age of disease onset was 2[1; 3] years old. Most of the patients had difficulty in breathing(42 of 49 cases). Seven patients had hoarseness.53.0% patients had subglottic or trachea papillomatosis spreading. The rate of complications, synechia formation, tracheal stenosis, needing for tracheostomy, mortality was recorded. Patients were followed up for at least three years. The characteristics of the patients, improvement in symptoms, recurrence-free interval, and the rate of tracheal extubation were evaluated. signed ranks test and chi-square test were used for data comparation. Long-term relieve in disease(≤2 surgeries were needed/year) were achieved in 29(59.1%) subjects, in which 8(16.3%) of the subjects did not need surgical treatment for at least 3 years. Long-term relieve had been achieved in 25 of subjects who did not accept tracheostomy. Seven subjects did not need surgical treatment for at least 3 years. The rate of successful tracheal extubation was 53.8% in 13 patients who had undergone tracheostomy. Three cases dead of intrapulmonary spread. Combined techniques of laser microsurgery and microdebriders are effective in improvement in both respiratory distress and voice quality. The combined technique are helpful to avoid inevitable long-term stenotic complications, ultimately affecting the quality of life.
青少年起病的复发性呼吸道乳头状瘤病（JORRP）可能是一种侵袭性且有潜在生命威胁的疾病。为强调在局部切除手术中预防并发症的重要性，报告了一组复发间隔相对较短（>4次/年）的RRP患者的单中心治疗经验。回顾性分析了2002年至2013年期间接受乳头状瘤切除术的49例患者的数据。采用激光显微手术和微型清创器联合技术切除乳头状瘤，预防瘢痕组织形成并改善呼吸窘迫。49例患者随访了99.0[74.5；121.0]个月，范围为39至185个月。发病年龄为2[1；3]岁。大多数患者有呼吸困难（49例中的42例）。7例患者声音嘶哑。53.0%的患者有声门下或气管乳头状瘤扩散。记录了并发症、粘连形成、气管狭窄、气管切开需求、死亡率。患者至少随访三年。评估了患者的特征、症状改善情况、无复发间隔以及气管拔管率。采用符号秩检验和卡方检验进行数据比较。29例（59.1%）受试者实现了疾病的长期缓解（每年所需手术≤2次），其中8例（16.3%）受试者至少3年无需手术治疗。未接受气管切开术的25例受试者实现了长期缓解。7例受试者至少3年无需手术治疗。13例接受气管切开术的患者气管拔管成功率为53.8%。3例死于肺内扩散。激光显微手术和微型清创器联合技术在改善呼吸窘迫和声音质量方面均有效。联合技术有助于避免不可避免的长期狭窄并发症，最终影响生活质量。
