儿童复发性喉乳头状瘤样病变的临床研究

Diagnosis and treatment of juvenile recurrent laryngeal papillomatosis

目的 探讨儿童喉乳头状瘤样病变 (juvenilrecurrentlaryngealpapillomatosis,JRLP)的治疗方法及儿童复发性呼吸道乳头状瘤 (juvenileonsetrecurrentrespiratorypapillomatosis,JORRP)与小儿喉尖锐湿疣 (infantilelaryngealcondylomaacuminatum ,ILCA)的关系。方法 回顾分析 1994年 3月～ 2 0 0 2年 3月诊治的 4 4例JRLP的临床资料。结果 4 4例中普通组织病理学诊断为ILCA 2 8例 ,JORRP 16例 ;采用斑点杂交和聚合酶链反应检测人乳头状瘤病毒阳性率达 4 2 / 4 4。JRLP患儿平均初诊时间 1 6岁 ,平均手术次数 5 3次 ,平均手术间隔期 2 4个月 ;在总共 2 33次手术中 ,各种并发症总发生率为 3 9%。目前 ,长期缓解 18例 ,正在随访的有 11例 ,失访 10例 ,死亡 5例。手术加有治疗目的的气管切开 (延长手术间隔期 )和手术加中药两种治疗方式效果较好。JORRP和ILCA存在广泛的共性。结论 深入研究JORRP和ILCA的关系具有十分重要的理论价值和临床意义。应尽量避免用气管切开术来缓解JRLP所引起的喉梗阻 ,手术加有治疗目的的气管切开术和手术加中药治疗两种治疗方式值得进一步探讨。

Objective To evaluate some perplexing problems in the diagnosis and treatment of juvenil recurrent laryngeal papillomatosis(JRLP) and the relationship between juvenile onset recurrent respiratory papillomatosis(JORRP) and infantile laryngeal condyloma acuminatum(ILCA). Methods A group of 44 cases with JRLP were analyzed retrospectively from March, 1994 to March, 2002 in the light of literature review. Results The average age of first visit was 1.6 years. Average 5.3 operations had been performed per patient. There was an interval of average 2.4 months between two surgical excisions. Of 233 operations, the total incidence rate of all the complications was 3.9%. At present, the laryngeal lesion of 18 cases have withered away for over 1 year. 11 cases have being followed up. 10 cases have lost follow-up and 5 cases have died(11.4%). Combined laryngeal lesion excision with tracheotomy aiming at prolonging operative interval or Chinese traditional medicine has received more satisfactory effect than other therapies. There is an extensive similarity between JORRP and ILCA. Conclusions To demondtrate further whether JORRP and ILCA are the same identical disease has important significance in both theoretical study and clinic practice. The treatment for JRLP is still difficult. The tracheotomy for laryngeal obstruction resulted from the laryngeal lesion of JRLP should be avoided as far as possible. Combined laryngeal lesion excision with tracheotomy aiming at prolonging operative interval or Chinese traditional medicine shows optimistic prospect.