儿童复发性喉乳头状瘤的手术间隔Logistic回归分析及手术时机的选择

Choice of timing of surgery for juvenile onset recurrent respiratory papillomatosis

目的探讨儿童复发性喉乳头状瘤（juvenile onset recurrent respiratory papillomatosis,JORRP）手术间隔时间的影响因素及手术时机的选择。方法回顾性分析73例JORRP患儿共行289次手术的完整临床资料。探讨不同年龄段的JORRP患者手术间隔时间、临床表现及其手术的危险性及并发症。结果所有患者均未发生围手术期死亡病例及严重并发症。Logistic回归分析显示随年龄增大,手术间隔时间逐渐延长,而声带粘连及肿瘤生长范围广泛明显缩短手术间隔时间。呼吸困难Ⅲ~Ⅳ度患者围手术期不良事件的发生率明显高于Ⅰ~Ⅱ度患者,差异有统计学意义（χ2=53.327,P〈0.0001）结论不超过Ⅱ度呼吸困难可作为JORRP的手术时机,患者的年龄,肿瘤生长范围及声带有无粘连影响手术间隔时间。

OBJECTIVE To investigate the factor of the intersurgical intervals and the choice of timing of operation for juvenile onset recurrent respiratory papillomatosis（JORRP）. METHODS The complete clinical data of 73 cases of JORRP and 289 operations were retrospectively analyzed. The clinical data included the intersurgical intervals,clinical manifestation,the operating risk and complications in different children of different ages. RESULTS No perioperative period death or serious complications occurred in all of the operations. Logistic regression statistical analysis showed the intersurgical intervals which were prolonged accompanying with the growth of age and were shortened for the adhesions of vocal cords and extensive distribution of the tumors. Adverse events happened in the perioperative period of Ⅰ-Ⅱ degree dyspnea patients were obviously higher than in the Ⅲ-Ⅳ degree dyspnea ones（χ2=53.327,P〈0.0001）. CONCLUSION Patients with less than Ⅱ degree dyspnea can be selected as the candidate for operation in JORRP. The intersurgical intervals are related with the age, the range of papilloma and the adhesion of vocal cords.