儿童复发性喉乳头状瘤样病变的临床研究

目的 探讨儿童喉乳头状瘤样病变(juvenil recurrent laryngeal papillomatosis，JRLP)的治疗方法及儿童复发性呼吸道乳头状瘤(juvenile onset recurrent respiratory papillomatosis，JORRP)与小儿喉尖锐湿疣(infantile laryngeal condyloma acuminatum，ILCA)的关系。方法 回顾分析1994年3月～2002年3月诊治的44例JRLP的临床资料。结果 44例中普通组织病理学诊断为ILCA 28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42／44。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233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。     

小儿喉尖锐湿疣诊治中几个临床问题的探讨

目的 探讨小儿喉尖锐湿疣（ILCA）诊治中的几个临床问题及ILCA与小儿复发性呼吸道乳头状瘤病（JORRP）的关系。方法 结合文献复习，回顾分析1994年3月-2001年3月诊治的38例ILCA的临床资料。结果 本组ILCA患儿平均初诊时间1.5岁，平均手术次数5.6次，平均手术间隔期2.2个月；在213次手术中，各种并发症总发生率为3.75%。目前，缓解15例，正在随访的9例，失访9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。结论 ILCA和JORRP存在广泛的共性。应视为同一开（延长手术间隔期）和手术加中药两种治疗方式效果较好。结论 ILCA和JORRP存在广泛的共性。应视为同一疾病，ILCA的治疗仍是一个临床难题，应尽量避免用气管切开术来缓解ILCA病灶所引起的喉阻塞，手术加有治疗目的的气管切开和手术加中药治疗两种治疗方式值得进一步发展和探讨。     

幼年型复发性呼吸道乳头状瘤气管切开的临床研究

目的：分析幼年型复发性呼吸道乳头状瘤（JORRP）气管切开患儿的临床特征,探讨气管切开的拔管时机。方法：对31例接受气管切开术的JORRP患儿进行回顾性分析,分析JORRP的发病年龄、气管内播散的部位、疾病侵袭性、病变生长方式等临床表现。结果：31例JORRP患儿共行气管切开术32例次,3例次为手术后1个月拔除气管套管,气管内无乳头状瘤生长,其余29例次气管内均有不同程度的乳头状瘤生长;20例次拔管患儿中,拔管3个月以上者气管内未见乳头状瘤生长。结论：JORRP患儿应尽量避免气管切开,已行气管切开的患儿应及早拔管,避免乳头状瘤向气管内发展,拔管时机可选择在乳头状瘤生长较少时,可于手术结束后即刻拔除,或术后堵管24h后拔除。     

联合疗法治疗儿童复发性喉乳头状瘤46例临床观察

目的探讨手术切除联合液氮冷冻及鸦胆子油涂抹治疗儿童复发性喉乳头状瘤（JRLP）的方法。方法回顾性分析1996-2007年间收治的46例JRLP患者的临床资料，采用支撑喉镜下手术切除联合液氮冷冻及鸦胆子油涂抹的治疗方案。结果对46例患者随访2～3年，缓解34例，正在随访7例，失访5例。2例前联合轻度粘连、声嘶明显，无明显喉狭窄及气管内播散病例。结论手术切除结合液氮冷冻及鸦胆子油涂抹的治疗方法具有较好的疗效。     

儿童复发性呼吸道乳头状瘤的外科治疗

目的探讨儿童复发性呼吸道乳头状瘤病的外科治疗方法及手术并发症的预防对策。方法回顾性分析1993年5月到2006年3月56例儿童复发性呼吸道乳头状瘤病的临床资料，采用支撑喉镜喉显微外科手术，手术方式包括喉钳直接切除、喉钳咬除配合激光手术、电动吸割配合激光手术，其中8例行气管切开术。结果平均手术间歇期6．5月，4岁前平均手术间期3．2月，4岁后平均手术间期7．8月；随访3年以上未复发23例，失随访9例，22例仍在继续治疗中，死亡2例，包括术中窒息死亡1例，心肺功能衰竭死亡1例，短暂窒息8例，远期喉狭窄6例，喉气管狭窄3例。结论外科干预是目前治疗儿童复发性呼吸道乳头状瘤病最有效的方法，应用喉显微外科手术，配合电动吸割系统及激光手术，能有效减少手术创伤，延长手术间期，降低近、远期并发症。     

鼻内镜治疗小儿复发性呼吸道乳头状瘤病6例

目的：介绍鼻内镜下治疗小儿复发性呼吸道乳头状瘤病(JORRP)方法。方法：回顾性分析在鼻内镜引导下,经气管造口手术治疗6例小儿(JORRP)气管内播散肿瘤的诊治经验。结果：所有病例手术后恢复快,无明显并发症发生。鼻内镜下经气管切口手术术后复发时间平均5．4个月,经支气管镜等手术方法治疗平均复发时间2．2个月。结论：采用鼻内镜引导下行气管内乳头状瘤手术,术中视野清晰,能有效地清除肿瘤,避免损伤气管内正常黏膜,减少肿瘤复发频率。     

小儿复发性呼吸道乳头状瘤病38例临床分析

目的 :探讨小儿复发性呼吸道乳头状瘤病 (JORRP)的临床特点。方法 :回顾分折 1986年 6月～ 2 0 0 0年 6月收治的 JORRP 38例资料。结果 :平均发病年龄 2 .9岁 ,首次诊断平均年龄 3.5岁 ,平均手术 3.45次 ,术后并发喉功能障碍 8例 (2 1.0 5 % ) ,气管切开 19例 (5 0 .0 % ) ,6例气管造口有乳头状瘤传播 (31.5 8% )。结论 :JORRP是儿童最常见的喉部肿瘤 ,由于易复发 ,常需多次手术 ;手术应注意保存喉部正常组织 ;气管切开要慎重 ,以防病变局部接种和邻近器官传播     

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

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 ,气管切开术应该而且可以避免     

呼吸道乳头状瘤HPV DNA定量检测与临床特征分析

目的探讨幼年型呼吸道乳头状瘤病(juvenile onset recurrent respiratory papillomatosis,JORRP)的临床特点及病程的相关影响因素,研究JORRP瘤体中人乳头状瘤病毒(human papillomavirus,HPV)的基因含量及其临床意义。方法收集55例JORRP患儿的临床资料,应用荧光定量聚合酶链反应(polymerase chain reaction,PCR)法检测肿瘤组织中的HPV6/11含量,并进行临床随访观察复发情况。结果JORRP发病高峰在3～4岁,2～7岁组患儿的手术间隔时间小于大于7岁以上组患儿;行气管切开术的患儿的手术次数明显多于未行气管切开手术的患儿;55例JORRP标本经荧光定量PCR检测后35例(63.6%)为HPV6/11型阳性,其DNA中位拷贝数为2.2E 07,其拷贝数与JORRP病程无明显相关性。结论2～7岁为JORRP好发及易复发年龄段,气管切开会增加患儿手术次数与风险,JORRP患儿的病程变化与HPV6/11 DNA含量无明显相关。     

幼年型复发性呼吸道乳头状瘤术后并发症相关因素分析

目的:分析幼年型复发性呼吸道乳头状瘤(JORRP)术后并发症形成的原因和相关因素.方法:对2017-2019年于首都医科大学附属北京同仁医院行手术治疗的170例JORRP患儿进行随访,并回顾性分析患儿的临床资料,记录性别、发病年龄、病灶位置、临床表现、手术方式、气管切开术史、组织病理学结果、手术次数、手术间隔、术后并发...     

Tracheal, bronchial, and pulmonary papillomatosis in children

OBJECTIVES: To compare the clinical course of tracheal, bronchial, and pulmonary papillomatosis with clinical course of laryngeal papillomatosis in children. STUDY DESIGN: The records of the 448 children with recurrent respiratory papillomatosis treated in St. Vladimir Moscow Children's Hospital between 1988 and 2003 were reviewed. In all cases, the diagnosis was confirmed histologically. Age at onset of symptoms, age at first surgery, number of surgical procedures, mean duration of surgical interval, possible causes, and age at a point of papillomatosis spread in the lower airways and course of the disease were analyzed. SETTING: Academic children's hospital. RESULTS: Papillomas extension down to lower airways was observed in 40 children (8.9%). Among 40 patients with lower airway recurrent respiratory papillomatosis, 8 (20%) demonstrated pulmonary involvement. The basic cause of papilloma extension to lower airways appeared to be tracheotomy performed in children with laryngeal papillomatosis (92.5% of cases). Incidence of satellite pharyngeal and esophageal papillomatosis is significantly higher in patients with lower airways papillomatosis, presenting evidence of lager process extension. The clinical course of lower airways papillomatosis is more aggressive as compared with laryngeal papillomatosis, and treatment efficacy in such children is lower. CONCLUSIONS: All the patients with laryngeal papillomatosis having a history of tracheotomy require a regular endoscopic control and chest radiographs or computed tomography scanning because tracheal or pulmonary papillomatosis may occur in such patients even several years after decannulation. The prognosis for the disease after development of pulmonary papillomatosis is always serious.     

Anti-viral injectable treatment (cidofovir) in laryngeal papillomatosis

Laryngeal papillomatosis, due to type 6 and 11 papova-virus A, causes devastating lesions leading to difficult clinical situations (severe dysphonia, or laryngeal dyspnea). Recurrence requires repeated endoscopy with CO2 laser treatment to keep the airways free and prevent the lesions spreading. In patients presenting aggressive papillomatosis, such repeated intervention causes irreversible lesions which have a very negative impact on the vocal prognosis. In this context, developing a form of minimally invasive surgery would help avoid vocal sequelae as far as possible. Thus, anti-viral agents can be injected directly into the lesion per-operatively so as best to preserve the healthy mucosa and muscles, thereby managing the lesions with precision and less iatrogenic impact than with CO2 laser. Twenty six patients since 1998 have undergone Cidofovir endoscopy. Total remission was achieved in eight of them (31%), after between two and eight interventions. Twenty seven (65%) showed clinically significant partial remission. Such positive results were obtained in both adults and children. Associated lesion excision was required in cases of obstructive or persistent papilloma. Intralesion Cidofovir injection thus seems to have proved highly effective in the clinical management of laryngeal papillomatosis. Combined Cidovir injection and surgical excision remains necessary in case of large or persistent papillomas. These results have lead us to indicate this procedure as primary treatment for laryngeal papillomatosis in adults and children.     

Larynxpapillomatose

Papillomas are rare tumors that originate from the mucosa. They may appear in the nose, paranasal sinuses, oral cavity, larynx, trachea, or the skin. Papillomas are mainly asymptomatic and are therefore mostly diagnosed coincidentally. In contrast, laryngeal papillomatosis may cause stridor, dyspnoea, and hoarseness. A viral cause of the disease seems likely, especially human papilloma virus. Mechanical irritation is also a possible reason when the nose, oral cavity, or oropharynx is affected. All papillomas, independent of their origin, may recur, and have the possibility of malignant degeneration in common. The therapy of choice is complete surgical excision. Regarding laryngeal papillomatosis, laser vaporisation or excision using the CO₂ laser is recommended. Because retreatments using conventional modalities are frequently necessary, especially in the case of laryngeal papillomatosis, adjuvant therapies are applied with the aim of reducing the recurrence rate and prolonging the interval between treatments.     

Transoral robotic excision of laryngeal papillomas with Flex® Robotic System — A novel surgical approach

Introduction

Recurrent respiratory papillomatosis results in hoarseness, stridor and airway obstruction. Management is surgical, with most surgeons using microdebrider or laser. Transoral robotic surgery (TORS) has been successfully utilised for the excision of oropharyngeal malignancies and paediatric airway surgery. This is the first case report of TORS being used for the excision of laryngeal papillomas.