经喉内镜手术治疗儿童复发性喉乳头状瘤

Improvement of surgical management for Juvenile-onset recurrent laryngeal papilloma——the experience of Sun Yat Sen University

目的：探讨不同手术方式对儿童复发性喉乳头状瘤（JORLP）复发间隔时间和缓解期长短的影响。方法：1996年10月至2003年1月中山大学附属第三、第二、第一三家医院耳鼻咽喉科复发性喉乳头状瘤住院患儿88例，男52例，女36例，年龄10月。13岁，平均4．3岁。30例采用序贯手术治疗，即患儿住院期间先后接受2次手术．间隔5．7d，58例采用传统手术方法治疗，随访1．5-6年，平均3．5年。结果：接受序贯手术治疗的30例，复发间隔时间1．5．31个月，平均为8．7个月，15例（50%）获得长期缓解，接受传统手术治疗的58例，肿瘤再发间隔时间1．7～15个月，平均为5．3个月，16例（27．6％）获得长期缓解。两组比较，经卡方检验长期缓解差异有显著性（X=4．353．P〈0．05）；经t检验复发间隔时间差异有极显著性（t=3．038，P〈0．005）。结论：序贯手术治疗有助于延长儿童复发性喉乳头状瘤的手术间隔时间和缓解期，有助于减少气管切开和保护喉功能。

Objective： In order to implore the effect of different treatment modalities on the interval of recurrent and the time of remission of children with juvenile-onset recurrent laryngeal papilloma. Method： Eighty-eight children suffering from juvenile-onset recurrent laryngeal papilloma were admitted to our three affiliated hospitals including the third, second and the .first hospital of Sun Yat Sen University between October 1996 and January 2003. Their age were from 10 months to 13 years with an average of 4.3 year and male were 52 cases, female 36 cases. Of which 30 cases were treated with sequential surgery that means the child underwent twice intralaryngeal videoendoscopic surgery with a 5-7 days interval during hospitalization and other 58 eases were treated by routine surgery. All patients were followed up for 1.5 to 6 years with a mean of 3.5 years. Result： Thirty eases underwent sequeniial surgery had a recurrent interval of 1.5-31.0 months, averaged 8.7 months, of which 15 （50%） eases had long remission. Fifty-eight eases underwent routine surgical therapy had a recurrent interval of 1.7-15months, averaged 5.3 months, of which 16 （27.6%） eases had long remission. The difference of long remission was statistically significant in sequential surgery group, X= 4.353,P〈0.05, compared to the routine surgery group. The difference of the recurrent interval between groups was also significant, t =3.038,P〈0.005. Conclusion： The clinical study suggested that sequential surgical therapy is helpful to prolong the interval of recurrent, promote the remission, reduce the probability of tracheotomy and reserve the function of larynx of children with juvenile-onset recurrent laryngeal papilloma.