Interventional Pulmonology Assistant Professor of Medicine, Fox Chase Cancer Center, Philadelphia, PA.
Section of Interventional Pulmonology & Thoracic Oncology, Division of Pulmonary, Allergy & Critical Care, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA.
Surg Technol Int. 2021 May 20;38:139-143. doi: 10.52198/21.STI.38.GS1408.
Adult Recurrent Respiratory Papillomatosis (RRP) is a rare disease caused by the human papilloma virus in which papilloma grows from the respiratory epithelium. Patients can suffer from significant respiratory distress secondary to tracheal or bronchial obstruction by papilloma and the mainstay of treatment is bronchoscopic debridement. There are a variety of techniques to resect the endoluminal tumor, including CO2 or YAG laser, argon plasma coagulation, microdebrider and cold forceps. There have been documented cases of healthcare workers contracting HPV after exposure to surgical smoke during ablation of papilloma and measures should be taken to avoid inhalation of the smoke plume. For proximal lesions that are accessible to a microdebrider, this appears to be a safe and effective technique that does not generate heat or surgical smoke. The rate of recurrence of adult-onset respiratory papilloma after initial debulking varies and adjuvant medical therapy including intralesional cidofovir, interferon, or oral indole-3-carbinol has been used to slow recurrence. Malignant transformation of adult-onset RRP to squamous cell carcinoma has been reported to occur in 3-7% of cases. Therefore, ongoing surveillance is needed to monitor for disease progression and malignant transformation. Here we describe three patients whose tracheal disease was managed with an Nd-YAG laser and microdebrider. One patient was treated with adjuvant systemic indole-3 carbinol and another was maintained with serial debridement only. The third patient presented with obstructing squamous cell carcinoma of the trachea and was treated with definitive chemoradiation. She presented with a new left mainstem lesion 6 months later which was diagnosed as RRP. She was started on indole-3 carbinol, but unfortunately it transformed to squamous cell carcinoma 8 months later.
成人复发性呼吸道乳头瘤病（RRP）是一种由人乳头瘤病毒引起的罕见疾病，其中乳头瘤从呼吸道上皮生长。患者可能因乳头状瘤引起的气管或支气管阻塞而遭受严重的呼吸窘迫，治疗的主要方法是支气管镜下清创。有多种技术可以切除内腔肿瘤，包括 CO2 或 YAG 激光、氩等离子凝固、微动力刀和冷钳。有记录在案的医护人员在切除乳头状瘤的过程中接触手术烟雾后感染 HPV 的病例，应采取措施避免吸入烟雾羽流。对于近端病变，微动力刀可以到达，这似乎是一种安全有效的技术，不会产生热量或手术烟雾。初次减瘤后成人呼吸乳头瘤的复发率各不相同，已使用辅助药物治疗，包括腔内西多福韦、干扰素或口服吲哚-3-甲醇，以减缓复发。成人 RRP 向鳞状细胞癌的恶性转化已报道发生在 3-7%的病例中。因此，需要进行持续监测以监测疾病进展和恶性转化。这里我们描述了三名患者，他们的气管疾病采用 Nd-YAG 激光和微动力刀进行治疗。一名患者接受了辅助全身吲哚-3 甲醇治疗，另一名患者仅接受了定期清创治疗。第三名患者因阻塞性气管鳞状细胞癌就诊，接受了根治性放化疗。她 6 个月后出现新的左主支气管病变，被诊断为 RRP。她开始服用吲哚-3 甲醇，但不幸的是，8 个月后转化为鳞状细胞癌。
