Perkins J A, Inglis A F, Richardson M A
Otolaryngology-Head and Neck Service, Madigan Army Medical Center, Tacoma, Wash, USA.
Arch Otolaryngol Head Neck Surg. 1998 Mar;124(3):281-7. doi: 10.1001/archotol.124.3.281.
To describe the presentation of, factors contributing to, and treatment of iatrogenic airway stenosis (IAS) associated with recurrent respiratory papillomatosis (RRP).
Retrospective case series.
Pediatric tertiary care center.
The charts of patients treated for RRP in our institution from 1980 to 1995 (N=50) were reviewed. Seven patients were identified as having IAS based on endoscopic findings.
Prevalence and types of IAS within our RRP patient population, methods used to treat IAS, and successful treatment of IAS.
Of the 7 patients identified, 3 had isolated posterior glottic stenosis (PGS) and 1 had isolated subglottic stenosis. The other 3 had multiple areas of IAS as follows: PGS with bronchial stenosis, supraglottic stenosis with PGS, and tracheomalacia with tracheal stenosis from a suprastomal granuloma. The factors associated with IAS were extensive papilloma growth in the posterior glottis, prolonged periods of frequent laryngoscopies, and the use of nonstandard therapies, which in our series included topical podophyllum resin or photodynamic therapy. Six patients, all of whom had tracheal RRP at some point in their disease process, required tracheotomy. Five patients required laryngotracheal reconstruction. Laryngotracheal reconstruction permitted decannulation in all cases. Tracheal papillomas became sessile and nonobstructive after decannulation. Laryngotracheal reconstruction with rib grafting was most frequently performed. Of our 50 patients, none who did not have IAS required a tracheotomy. Of the 44 patients who did not require a tracheotomy, only 1 had tracheal papillomas.
Occasionally, therapy for RRP is complicated by IAS. In our series, PGS was most common. Tracheotomy was associated with the presence of both IAS and distal RRP. In selected cases, laryngotracheal reconstruction can be successfully accomplished when RRP is present, and subsequent regression of tracheal RRP is likely.
描述与复发性呼吸道乳头状瘤病（RRP）相关的医源性气道狭窄（IAS）的表现、促成因素及治疗方法。
回顾性病例系列研究。
儿科三级护理中心。
回顾了1980年至1995年在我们机构接受RRP治疗的患者病历（N = 50）。根据内镜检查结果，确定7例患者患有IAS。
RRP患者群体中IAS的患病率和类型、治疗IAS的方法以及IAS的成功治疗情况。
在确定的7例患者中，3例为孤立性声门后狭窄（PGS），1例为孤立性声门下狭窄。另外3例有多个IAS区域，分别为：PGS合并支气管狭窄、声门上狭窄合并PGS、气管软化合并气管造口处肉芽肿所致气管狭窄。与IAS相关的因素包括声门后广泛的乳头状瘤生长、频繁喉镜检查的长时间疗程以及使用非标准疗法，在我们的系列研究中包括局部使用鬼臼树脂或光动力疗法。6例患者在病程中的某个时间点均有气管RRP，需要行气管切开术。5例患者需要进行喉气管重建术。喉气管重建术使所有病例均能拔管。拔管后气管乳头状瘤变为无蒂且无阻塞性。最常进行的是带肋软骨移植的喉气管重建术。在我们的50例患者中，没有IAS的患者均未需要气管切开术。在44例不需要气管切开术的患者中，只有1例有气管乳头状瘤。
偶尔，RRP的治疗会因IAS而复杂化。在我们的系列研究中，PGS最为常见。气管切开术与IAS和远端RRP的存在相关。在某些选定病例中，当存在RRP时，喉气管重建术可以成功完成，并且气管RRP随后可能会消退。
