气管切开术与儿童复发性呼吸道乳头状瘤病气管内扩散的关系

The relationship between tracheotomy and intra-tracheal papilloma progression in children

目的 探讨气管切开术与儿童复发性呼吸道乳头状瘤病的关系 ,介绍避免气管切开和处理喉、气管乳头状瘤的经验。方法 1992年 5月至 1997年 7月收治患儿 6 2例。男 32例 ,女 30例。发病年龄 1个月至 8岁 4个月 ,平均 2岁 2个月。除 4例放弃继续治疗外 ,其他患儿共接受喉肿物摘除术、支撑镜下喉显微激光手术和 /或支气管镜检查、气管内肿物摘除术 16 3次。结果 2 1例气管切开并长期戴管的患儿中 17例 ( 80 .9% )发生气管病变 ,33例未气管切开的患儿中仅 2例 ( 6 .1% )发生气管病变 ,4例较早 ( <2月 )拔管的患儿中有 1例 ( 2 5 % )出现气管内病变。统计结果表明 ,气管切开与未切开患儿平均年龄、性别差异无显著性 (P >0 .0 5 ) ,气管切开与气管病变的出现有极密切的关系( χ2 =2 7 4,P <0 .0 0 5 )。结论 气管切开对肿瘤向下进展有促进作用 。

Objective To clarify the relationship between tracheotomy and intra-tracheal papilloma progression and introduce the experience of managing dyspnea in the hospital. Methods Children who were treated in ENT department of Tongren Hospital between 1992 and 1997 were reviewed in this essay. There were totally sixty-two children(thirty-two boys and thirty girls) with laryngeal papilloma and recurrent respiratory papillomatosis enroled in the series. Results Among 33 nontracheotomied children the intratracheal lesions were found in only 2 cases(6.1%). There were 17 (80.9%) cases presented intra-tracheal lesions in 21 tracheotomied cases, and it showed great statistical difference (χ2=274,P<0.005).There were no difference of onset age, sex and the first sites of papilloma lesions between the non-tracheotomied and tracheotomied groups(P>0.05). Conclusion We found papilloma has a weak potential to progress into trachea. Tracheotomy is the most important factor of intra-tracheal papilloma progression in many cases. The tracheotomy can be avoided.