Mahnke C G, Werner J A, Fröhlich O, Lippert B M, Hoffmann M, Rudert H H
Klinik für Hals-, Nasen- und Ohrenheilkunde, Kopf- und Halschirurgie, Christian-Albrechts-Universität Kiel.
Laryngorhinootologie. 1998 Mar;77(3):157-64. doi: 10.1055/s-2007-996952.
Recurrent laryngeal papillomatosis is a benign neoplastic disease which is probably caused by but at least associated with the human papillomavirus. It can be of significant importance for the affected patients because of its recurrent clinical course. A great variety of therapeutic measures has been described including the surgical removal either with conventional instruments or using the laser. Development of malignancies from papillomas have been reported.
The clinical courses of all 95 patients who have been treated for laryngeal papillomatosis since 1960 were analysed retrospectively. The two most common forms of treatment, surgical removal either conventionally or with the use of the laser, were compared. "Hot start" polymerase chain reaction and Southern blot hybridization were used to detect HPV DNA. The case reports of all patients developing cancer of the larynx are included.
Laryngeal papillomatosis is a disease of all ages, more often first diagnosed in the first and fourth decade. Puberty had no effect on the clinical course. The different forms of treatment did not affect the rate of recurrence. However, the rate of complications such as tracheostomy and glottic webs was significantly reduced after laser surgery. Since the introduction of this new form of therapy no more tracheostomies had to be performed on these patients. HPV DNA was found in four of five samples (HPV 6:3, HPV 11:1). Squamous cell carcinoma subsequently developed in four cases, three of which occurred almost simultaneously and were therefore not included.
The term juvenile laryngeal papillomatosis should be replaced by recurrent respiratory papillomatosis. One could then distinguish according to the age of onset, i.e., in children below the age of 16 years and in adolescents and adults older than 15 years. The occurrence of squamous cell carcinomas in patients previously treated for papillomas underlines the need for repeated histological studies. The surgical treatment remains the mainstay in the management of laryngeal papillomatosis. The laser surgical technique is superior to conventional removal. Using the at present most sensitive and specific methods HPV DNA can be detected in a large percentage of laryngeal papillomas.
复发性喉乳头状瘤病是一种良性肿瘤性疾病，可能由人乳头瘤病毒引起，至少与之相关。由于其临床病程呈复发性，对受影响的患者可能具有重要意义。已经描述了各种各样的治疗措施，包括使用传统器械或激光进行手术切除。有报道称乳头状瘤可发展为恶性肿瘤。
回顾性分析了自1960年以来接受喉乳头状瘤病治疗的所有95例患者的临床病程。比较了两种最常见的治疗方式，即传统手术切除和使用激光切除。采用“热启动”聚合酶链反应和Southern印迹杂交检测人乳头瘤病毒DNA。纳入了所有发生喉癌患者的病例报告。
喉乳头状瘤病是一种各年龄段均可发生的疾病，首次诊断多在第一个和第四个十年。青春期对临床病程无影响。不同的治疗方式不影响复发率。然而，激光手术后气管切开术和声门蹼等并发症的发生率显著降低。自从引入这种新的治疗方式后，这些患者不再需要进行气管切开术。在五个样本中有四个检测到人乳头瘤病毒DNA（人乳头瘤病毒6型：3例，人乳头瘤病毒11型：1例）。随后有四例发生鳞状细胞癌，其中三例几乎同时发生，因此未纳入分析。
“青少年喉乳头状瘤病”这一术语应被“复发性呼吸道乳头状瘤病”取代。然后可以根据发病年龄进行区分，即16岁以下儿童以及15岁以上的青少年和成年人。先前接受乳头状瘤治疗的患者发生鳞状细胞癌，突出了重复进行组织学检查的必要性。手术治疗仍然是喉乳头状瘤病管理的主要方法。激光手术技术优于传统切除术。使用目前最敏感和特异的方法，可以在很大比例的喉乳头状瘤中检测到人乳头瘤病毒DNA。
