Morrison G A, Kotecha B, Evans J N
Department of Paediatric Otolaryngology, Hospital for Sick Children, London.
J Laryngol Otol. 1993 May;107(5):423-6. doi: 10.1017/s0022215100123321.
Juvenile respiratory papillomatosis involving the tracheo-bronchial tree imposes a significant management problem and is sometimes life threatening. The mainstay of treatment is repeated vapourization with a CO2 laser. To date, adjunctive medical treatments have been of limited value. A tracheostomized child with extensive laryngo-tracheo-bronchial papillomatosis who has required bronchoscopic lasering at two-weekly intervals for three years was treated with ribavirin, a broad spectrum anti-viral agent. The drug was administered in nebulized form using a small particle aerosol generator (S.P.A.G.) to the lower respiratory tract (6 gm/150 ml over nine hours) on three consecutive nights every two weeks over seven weeks and also administered orally (15 mg/kg/day). Endoscopic assessments were made every two weeks. At 14 days the papillomata were regressing and far less lasering was required. No further lasering was required up to 56 days. One month after stopping the ribavirin, however, a few sessile papillomata in the tracheo-bronchial tree had recurred and were treated with the laser. No adverse reactions were encountered. During the treatment period there was a significant reduction in the frequency of therapeutic endoscopies. This promising response requires further evaluation to define the role of ribavirin in the treatment of juvenile respiratory papillomatosis.
累及气管支气管树的青少年呼吸道乳头状瘤病带来了重大的治疗难题，有时甚至会危及生命。治疗的主要方法是用二氧化碳激光反复汽化。迄今为止，辅助药物治疗的价值有限。一名气管切开的儿童患有广泛的喉气管支气管乳头状瘤病，三年来每两周需要进行一次支气管镜激光治疗，现用广谱抗病毒药物利巴韦林进行治疗。该药物通过小型颗粒气雾剂发生器（S.P.A.G.）以雾化形式给药至下呼吸道（9小时内6克/150毫升），每两周连续三个晚上给药，共七周，同时也口服给药（15毫克/千克/天）。每两周进行一次内镜评估。14天时乳头状瘤开始消退，所需的激光治疗大大减少。直至56天均无需进一步的激光治疗。然而，在停用利巴韦林一个月后，气管支气管树中出现了一些无柄乳头状瘤，遂用激光进行治疗。未出现不良反应。在治疗期间，治疗性内镜检查的频率显著降低。这种有前景的反应需要进一步评估，以确定利巴韦林在青少年呼吸道乳头状瘤病治疗中的作用。
