局部给药光动力疗法治疗儿童喉乳头状瘤

Photodynamic therapy by topical drup for the treatment of juvenile onset laryngeal papillomatosis

目的:观察局部给药的光动力疗法治疗儿童喉乳头状瘤的疗效。方法:28例喉乳头状瘤患儿,平均外院手术治疗4次,切除肉眼可见瘤体后,局部贴敷20%的5-氨基酮戊酸(光敏剂)3h,用635nm的半导体光动力激光,200~280mW,能量密度80~120J/cm^2,照射20min。25d左右重复照射,直至无肉眼可见肿瘤后再照射2次。结果:随访1年以上24例(其中12例随访3年),19例(79.2%)未发现复发;5例(20.8%)复发,其中2例放弃治疗,3例在追加3次治疗后肿瘤消失。主要并发症是喉粘连。结论:局部给药光动力疗法治疗儿童喉乳头状瘤的初步疗效较好,可明显减少肿瘤复发。

Objective：To observe the therapeutic effect of photodynamic therapy（PDT） on the treatment of ju- venile onset laryngeal papillomatosis. Method.. Twenty-eight cases of children with laryngeal papilloma were trea- ted,only 2 cases for the first time, and the rest were repeatedly treated outside our hospital, the average hospital surgery were more than 4 times. Under self retaining laryngoscope and microscope and endoscope assisted by sem- iconductor laser and plasma and cold instrument method,visible tumor resection and local affixed deposited 20 % 5- aminolevulinic acid（photosensitizer） 3 hours later, with 635 nm semiconductor laser photodynamic, 200--280 mW and can volume density of 80 to 120 J/cm^2 , 20 min irradiation. PDT should be repeated after 25 days until no visi- ble tumor. Then,2 times PDT must be done. Result：In 28 cases, 24 cases were followed up for more than 1 years （12 cases were followed up for 3 years）, 19 had no recurrence, the cure rate was 79.2%（19/24）; 5 cases recur- rence, and the recurrence rate was 20.8 % （5/24）,among them, 2 cases were abandoned because of the relapse, the other 3 cases were cure after 3 times of PDT. The main complications were adhesion of larynx. Conclusion： The pre- liminary effect of PDT by topical drug for the treatment of juvenile onset laryngeal papillomatosis is encouraging. The principle of PDT and the principle of the recurrence of laryngeal papilloma in children were also introduced in this paper.