显微支撑喉镜下手术摘除加5-FU肿瘤基底部注射治疗喉乳头状瘤36例

目的探讨喉乳头状瘤的治疗方式.方法对1995年1月～2001年12月36例喉乳头状瘤患者在全麻高频通气显微支撑喉镜下手术切除加肿瘤基底部5-氟尿嘧啶(5-FU)局部注射,术后常规给予α-干扰素皮下注射进行回顾分析.结果喉乳头状瘤复发率降低,气管切开后易发生肿瘤种植.结论对喉乳头状瘤的治疗,强调手术摘除加肿瘤基底部5-FU注射是较为有效的方式,治疗中提倡微创,尽量实施内镜下手术,尽量避免喉裂开等手术,以免引起并发症.     

小儿喉乳头状瘤患者的免疫状态调查和局部注射5-氟脲嘧啶的疗效观察

喉乳头状瘤由人乳头状瘤病毒 (HPV)引起 ,以HPV6、1 1型多见。小儿患者发病年龄小 ,病变范围广 ,常侵及喉外组织 ,摘除后易复发 ,而成人患者则易发生癌变。复发性喉乳头状瘤的患儿多伴有体液或细胞免疫功能低下 ,抗病毒能力较差 ,病变范围广且容易侵及下呼吸道 ,使治疗变得尤为困难。 2 0 0 0～ 2 0 0 2年我们收治 9例小儿喉乳头状瘤患者 ,行手术摘除肿瘤后局部注射 5 氟脲嘧啶 ( 5 FU) ,并与 7例不注射 5 FU的对照组进行比较 ,以探讨小儿的免疫状态与肿瘤发生的相关性及局部注射 5 FU的治疗效果。1　资料与方法小儿喉乳头状瘤患者…     

显微支撑喉镜下CO2激光手术或联合干扰素治疗复发性小儿喉乳头状瘤疗效对比

目的 探讨白细胞干扰素联合显微支撑喉镜下CO2激光手术治疗复发性小儿喉乳头状瘤的临床疗效。方法 回顾性分析61例复发性小儿喉乳头状瘤的临床治疗资料,运用解剖划分法,评估单纯显微支撑喉镜下CO2激光治疗(A组)、或联合干扰素共同治疗(B组)复发性小儿喉乳头状瘤这两种方案的临床效果。结果 两组乳头状瘤范围,① 术前均为1～8个解剖亚区,平均值A组为(3.45±1.86)个、B组为(3.53±1.67)个解剖亚区;② 术后A组1～4个、平均(2.09±0.87)个解剖亚区,B组1～3个、平均(1.47±0.63)个解剖亚区(P<0.05)。结论 单纯显微支撑喉镜下CO2激光手术与联合干扰素治疗复发性小儿喉乳头状瘤均能延缓肿瘤复发,联合治疗组较单纯手术组复发范围小。     

小儿喉良性疾病的显微外科治疗

喉显微外科在临床广泛应用已有十几年的历史。我科在 1987～ 1997年10年间对 2 3例喉疾病小儿进行 2 7次显微喉手术治疗 ,取得了良好的效果。一、材料与方法2 3例患儿男 15例 ,女 8例 ;最小 1 5岁 ,最大 14岁 ,平均 5 3岁。声嘶病程最长为 3年 ,最短为 3个月。术前外院行气管切开术 2例 ,呼吸困难Ⅰ～Ⅲ度12例 ;1例手术 3次 ,2例手术 2次 ,均为喉乳头状瘤。病理结果 :声带息肉 11例 ,乳头状瘤 7例 ,喉狭窄 (声带粘连 ) 1例 ,喉纤维瘤 1例 ,声带囊肿 3例 ;病变位置 :息肉 :双侧声带 9例 ,单侧声带 2例 ,其中全程声带息肉 3例 ,最大约 1 0ｃ…     

喉乳头状瘤激光手术合并症

七十年代初CO_2激光显微手术开始用于治疗喉乳头状瘤,其优点是术野清楚,肿瘤组织气化无出血,能保持喉的正常支架。但喉乳头状瘤易复发,常需多次手术,要警惕手术合并症。作者统计1977年6月至     

鼻窦内镜在喉显微手术中的应用

目的 探讨显微镜下喉显微手术暴露不佳时,鼻窦内镜辅助手术的可行性,比较鼻窦内镜及显微镜在喉显微手术中的优缺点。方法 2004年1月至2009年12月应用鼻内镜辅助完成喉显微手术28例。结果 28例均一次手术成功,临床治愈,无明显并发症。除2例喉乳头状瘤外,其余均未见复发。结论 鼻内镜在喉显微手术中具有较显微镜视野更清晰、操作简便、精确度高、创伤性小、术后并发症少等优点。     

气管内窥镜在治疗小儿复发性气管内乳头状瘤中的应用

目的 :探讨小儿复发性喉乳头状瘤播散至气管内的治疗方法。方法 :利用气管内窥镜在全麻支撑喉镜下治疗小儿复发性气管内乳头状瘤 12例。结果 :12例中 ,3例随访 1年余未复发 ,已拔除气管套管 ;9例术后复发 ,但复发周期较既往应用气管镜手术明显延长 ,且病灶有逐渐局限、减少的趋势。结论 :应用气管内窥镜治疗气管内乳头状瘤 ,术野清楚 ,肿瘤摘除彻底 ,术后复发周期延长。     

喉显微切割钻在幼年型复发性气管内乳头状瘤治疗中的应用

目的:探讨幼年型复发性呼吸道乳头状瘤(JO-RRP)播散至气管后的治疗方法。方法:14例JO-RRP患儿均在全身麻醉支撑喉镜下应用气管内镜和喉显微切割钻治疗,手术间隔期内均未应用干扰素等药物治疗。结果:14例中,有8例经治疗3~6次后气管内乳头状瘤趋于局限,拔除气管套管,封闭气管造瘘口。随访6个月,气管内黏膜光滑,无乳头状瘤生长。6例尚未拔管,但肿瘤生长有明显减少的趋势。结论:应用喉显微切割钻治疗复发性气管内乳头状瘤,术野清楚,肿瘤切除彻底,并发症少,术后复发周期延长。     

治疗复发性喉乳头状瘤喉造口激光切除术

目的:研究治疗复发性喉乳头状瘤的方法.方法:为3例病变范围广泛或多次复发的喉乳头状瘤患者行喉造口激光切除术.结果:3例患者分别经过3次、2次、10次手术治愈,经过半年到3年的随访,肿瘤无复发,喉功能恢复良好.结论:1.此种术式通过一次喉造口,可充分暴露病变,反复精确地切除肿瘤,从而有效地减少了肿瘤种植及复发,可多次切除病变而不需反复行喉裂开术,损伤相对较小,适用于易复发且范围广的喉乳头状瘤;2.采用激光手术治疗喉乳头状瘤,可有效地恢复正常的喉功能,损伤小,疗效好.     

儿童复发性喉乳头状瘤临床治疗探讨

目的：探讨和评价鼻内镜下显微电动吸切术协同激光治疗儿童喉乳头状瘤的可行性和手术疗效。方法：回顾性分析26例复发性喉乳头状瘤患儿的临床资料,采用鼻内镜下显微电动吸切术6例,鼻内镜下显微电动吸切术协同激光治疗,并对术腔创面涂透明质酸钠凝胶20例,对2种手术方式的疗效进行分析评价。结果：在鼻内镜下行显微电动吸切术切除复发性喉乳头状瘤的患儿,术后4周纤维喉镜检查发现喉乳头状瘤复发,术后2～3个月需再次手术;鼻内镜下微电动吸切术协同激光治疗的患儿,术后2～3周内,喉部创面再次辅助激光治疗4～8次,16例患儿治愈,术后随访3～8年无复发,4例患儿复发间隔延长。结论：鼻内镜下显微电动吸切术协同激光治疗能有效降低喉乳头状瘤的复发,该术式要求术后短期内反复多次激光辅助治疗,并且对创面采用了透明质酸钠凝胶,从而避免声带瘢痕过大和粘连,大大提高了患儿的发声质量,部分患儿通过该手术方案的治疗能完全治愈。     

成人喉乳头状瘤恶变17例报告

目的 :探讨成人喉乳头状瘤恶变的临床特征、病理特点及远期治疗效果。方法 :发生恶变的 17例喉乳头状瘤患者中 ,4例 (声门型T3 N1M0 1例 ,声门上型T4N0 M0 1例 ,T4N1M0 2例 )施行了全喉切除术及单侧功能性颈廓清术 ,13例施行了喉裂开及喉部分切除术。术后辅以适当放疗 ,剂量 4 5～ 5 5Gy。 结果 :17例术后 1年内全部拔管 ,拔管率 10 0 %。随访 5年以上 ,4例全喉切除术中 ,1例术后 2年死于肿瘤复发 ,1例于术后 3年 4个月死于肿瘤远处转移 ,2例术后 8年无瘤生存 ,发食管音 ;13例喉裂开及喉部分切除术中 ,随访 3年生存 12例 ,失访 1例 ;5年生存 11例 ,远处转移死亡 1例。结论 :反复活检是术前确诊成人喉乳头状瘤恶变的重要方法 ;彻底的手术切除是治疗的重要手段。     

原发性喉血管肉瘤

目的研究喉血管肉瘤的临床病理特征、治疗及转归。方法对3例原发性喉血管肉瘤病理学和免疫组织化学特点、临床表现、治疗和转归及危险因素进行回顾性分析。结果本组病例共3例,占我院同期收治喉及喉咽恶性肿瘤的0.35%,女性1例,男性2例,年龄51～63岁,平均55.3岁,病程2～6个月,2例男性患者有长期吸烟史,3例患者分别进行了声带单侧切除、喉部分切除、喉全切除,并联合术后放疗,1例术后9个月死于局部复发,另外2例分别随访38、86个月,无瘤生存。结论喉血管肉瘤极为罕见,治疗以手术切除为主,不同病例间预后差异很大,治疗效果取决于病变的范围、肿瘤的分化程度及手术切缘情况。     

Lower airway papillomatosis in children

Laryngeal papilloma in children is a frequent disease caused by human papilloma virus (HPV) type 6 or type 11. This disease has a tendency to recur and the changes are histologically benign. In some cases papilloma may affect the lower levels of the respiratory tract. In this study, among 90 patients treated for laryngeal papillomatosis, in four children papilloma of trachea, bronchi and lung tissue were detected in endoscopic and radiological examination. This constitutes 4.4% of all patients. Compact nodules and acquired cysts between 5 and 50 mm long were found in chest X-rays and in computerised tomography. These cysts appeared from 4 to 8 years after establishing a diagnosis of laryngeal papilloma, and 1 year after recognising papilloma in the trachea. In all four children the presence of nodules and cysts in the lungs was preceded by recurrent pneumonia, emphysema or atelectasis of the lungs. All children with laryngeal papillomatosis should have a chest X-ray. Detection of acquired cyst-like changes in lung tissue in children with laryngeal papillomatosis is a warning of future papilloma in the trachea and bronchi, with involvement of lung tissue. In differential diagnosis of these changes in the lungs we should take into consideration the presence of papilloma in the bronchi. A prognosis of papillomatosis in the lower airways in children is always serious.     

9666例鼻咽喉部肿瘤病理分析

目的 了解鼻、咽、喉肿瘤发病的年龄、性别、部位及与病理类型的关系。方法 对华西医院病理科在1984～1999年间全部经病理诊断的9666例鼻、咽、喉肿瘤组织学类型的构成进行分析。结果 ①良、恶性肿瘤之比为1：8．6，在鼻咽部为1：62．0；②良性肿瘤21种，以乳头状瘤、血管纤维瘤和血管瘤多见；③恶性肿瘤25种，癌和肉瘤之比为11．98：1，以分化型非角化鳞状细胞癌最多见；④恶性肿瘤患者的发病年龄较良性肿瘤者约长10岁，且男性患者多于女性；⑤良性肿瘤以口咽鳞状上皮乳头状瘤最常见；恶性肿瘤以鼻咽癌为主，肉瘤以鼻腔淋巴瘤最常见。结论 鼻、咽、喉肿瘤的发病年龄、性别和部位与肿瘤的组织病理类型有一定关系。     

儿童复发性呼吸道乳头状瘤病临床研究

OBJECTIVE: To study the clinical behavior of juvenile-onset recurrent respiratory papillomatosis in order to find some factors correlated to the development of this disease, and to sum up the significance and experience of CO2 laser surgery. METHOD: Sixty patients with juvenile-onset recurrent respiratory papillomatosis from September 1995 to December 1998 were retrospectively analyzed. RESULTS: The age of onset in 50 cases (83.3%) was below 4 years, and the peak-age was 2 years. The rates of recurrence were 72.0% and 45.7% (chi 2 = 4.71, P < 0.05) below and over 2 years, respectively. The rates of aggressive disease were 88.0% and 54.3% (chi 2 = 7.66, P < 0.01) below and over 2 years, respectively. The predominant sites of the disease were the vocal cords, the false vocal cords, the laryngeal ventricle, the laryngeal surface of the epiglottis and the subglottic region. Tracheostomy induced the development of tracheal papilloma, therefore should be avoided as possible. Laryngeal papilloma might be divided into four types on the basis of the growth manner and surface form corresponding to clinical behaviors. Five patients were followed-up for 1.5 years without recurrence, 18 patients had fewer recurrences following treatment, 33 patients were under treatment, and 3 patients died. Nineteen patients lost follow-up. The major complications included laryngeal and tracheal stenosis. CONCLUSION: Clinical behaviors of juvenile-onset recurrent respiratory papillomatosis were relevant to the age, growth form and tracheotomy. CO2 laser was an ideal instrument for ablation of the laryngeal papillomas with the following advantages: simple management, less bleeding, preservation of laryngeal structure and avoidance of tracheostomy.     

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.     

Prognostic value of clinical findings in histologically verified adult-onset laryngeal papillomas

A retrospective study of adult-onset laryngeal papilloma was performed to clarify whether any clinical features at the time of diagnosis could predict its course. All patients had a histologically confirmed diagnosis of laryngeal papillomas and were treated at Helsinki University Hospital between 1975 and 1994. Those with adult-onset disease and follow-up exceeding 1 year (n = 74) entered the study. Based on the case records surveyed, results suggested two risk factors for frequent laryngeal procedures: young age at onset of papilloma and a lesion extending to the anterior third of the vocal folds. It was not possible to predict the course of the disease by such clinical findings as symptoms or size or number of primary papilloma lesions. As regards the recurrence of disease, the classic division of adult-onset laryngeal papilloma into solitary and multiple type was not found to be clinically relevant.     

小儿喉乳头状瘤切除术不同全麻诱导方式的对照研究

目的探讨儿童喉乳头状瘤伴呼吸困难病例更加安全可行的全麻诱导方式。方法选择喉阻塞Ⅱ度的喉乳头状瘤患儿50例,随机分为七氟烷吸入诱导组（吸入组）与氯胺酮．眯唑安定静脉诱导组（静脉组）,每组25例。分别记录诱导前、插管后1分钟血压、心率及脉搏血氧饱和度（saturated pulse oxygen,SpO2）变化并进行气管插管条件评分。结果①吸入组气管插管条件满意者16例,一般者7例,差者2例;静脉组气管插管条件满意者6例,一般者13例,差者6例,插管满意率吸人组明显高于静脉组,P〈0．05。②两组气管插管前血压、心率及SpO2无明显差异,P〉0．05。③插管完成后即刻静脉组血压和心率明显高于吸入组[（68．7±6．4）mmHgvs．（64．0±8．0）mmHg;（142．6±13．8）bpmvs．（124．6±12．5）bpm;P〈0．05];插管完成后即刻静脉组血压和心率明显高于插管前[（68．7±6．4）mmHg vs．（63．6±5．8）mmHg;（142．6±13．8）mmHg vs．（121．2±11．7）bpm;P〈0．05];吸入组血压和心率与插管前对比无显著差异[（64．0±8．0）mmHg vs．（61．8±7．7）mmHg：（124．6±12．5）bpm vs．（118．2±11．3）bpm;P〉0．05]。④静脉组3例插管后呛咳剧烈,SpO2低于93％：吸入组插管后未出现剧烈呛咳及SpO2下降。两组SpO2下降率存在明显差异,P〈0．05。结论七氟烷吸入诱导法,无需肌肉松弛剂即可提供良好的气管插管条件,用于存在呼吸困难的喉乳头状瘤患儿安全可行。与氯胺酮、咪唑安定静脉诱导相比,更利于保持循环稳定,减少插管后低氧血症发生。