累及气管幼年型复发性呼吸道乳头状瘤的手术策略

目的 探讨累及气管支气管的复杂幼年型复发性呼吸道乳头状瘤(juvenile on-set recurrent respiratory papillomatosis,JORRP)手术策略,以降低手术风险,减少并发症.方法 选取2006年1月至2009年2月间在北京同仁医院进行手术治疗,病变累及气管内的24例JORRP患儿,共行149次手术,手术均采用全麻,术中高频喷射呼吸机支持呼吸,支撑喉镜下使用气管内镜及喉电动切割钻治疗,应用辅助通气,切除肿瘤和清除气道内出血交替.结果 患儿年龄3～16岁(中位数6岁);首次发病年龄8个月～10岁(中位数1.5岁);有气管切开病史20例,患儿气管切开年龄1～4岁(中位数2岁);术前2度呼吸困难147例次,3度呼吸困难1例次,4度呼吸困难1例次.全部患儿均接受多次手术.所有患儿术后呼吸困难均完全缓解,无死亡病例.2例次术后因高碳酸血症再次插管,1例次因术前低氧血症、高碳酸血症,术后拔管人重症监护病房1日.结论 应用高频喷射呼吸机支持呼吸,支撑喉镜下使用气管内镜及电动切割钻治疗累及气管内的青少年型复发性呼吸道乳头状瘤,在间断无通气情况下切除气管内肿瘤的策略是安全有效的.

Strategy of surgical management of juvenile on-set recurrent respiratory papillomatosis with trachea or bronchia involvement

Objective To investigate the strategy of surgical management of juvenile on-set recurrent respiratory papillomatosis(JORRP)with trachea/bronchia involvement so as to decrease the complications of the surgery.Methods Twenty four JORRP patients undergone surgery in Beijing Tongren Hospital were studied between January 2006 and February 2009.All of them had JORRP with trachea/bronchia involvement.Suspension laryngoscopic surgeries were performed using rigid bronchoscope and micro-debrider.High frequency iet ventilator was used to maintain the ventilation in general anesthesia.Excision of tumors,suction of the blood and ventilation were preformed alternately.A total of 149 times of surgeries were analyzed.Results The age of the patients Was from 3 to 16 years old(median 6 years old).The age at diagnosis was from eisht months to 10 years old(median 1.5 years old).Twenty of them had undergone tracheostomy and the age at tracheostomy was from 1 to 4 years old(median 2 years old).Twenty two of them had been graded as two-degree dyspnea preoperatively,one graded as three-degree dyspnea and one four-degree dyspnea.All subjects underwent more than one surgery.Two cases were intubated and sent to intensive care unit because of postoperative hypercapnia.One was sent to intensive care unit postoperatively because of preoperative phypoxemia and hypercapnia.All subjects were discharged without dyspnea.No death and complications occurred.Conclusions Suspension laryngoscopic surgery using rigid bronchnscope and micro-debrider was a safe and effective strategy for the treatment of JORRP with trachea/branchia involvement.