下呼吸道乳头状瘤19例临床特征分析

目的探讨下呼吸道乳头状瘤(LRP)的临床特征及预后情况。方法回顾性纳入2008年10月至2020年10月广西医科大学第一附属医院经病理学确诊的19例LRP患者临床资料,其中男12例,女7例,按照年龄分为成人组7例,年龄(41.3±17.5)岁;儿童组12例,年龄(5.5±3.5)岁,其中10例起病年龄<5岁;分析其主要症状体征、临床、影像和病理学特点以及预后情况。结果本组患者的主要症状为咳嗽咳痰(13/19)、呼吸困难(15/19)、声嘶(10/19),主要肺部体征为喉鸣音或哮鸣音(7/19)。9例行胸部CT检查,观察到结节肿块影(9/9)、囊性薄壁空洞(4/9)、阻塞性肺炎(2/9)、肺不张(2/9)和毛刺征(1/9)。儿童组LRP患者均存在上呼吸道受累(12/12),成人组上呼吸道受累3例。18例(18/19)经支气管镜确诊,表现为桑葚样、乳头状肿物,1例(1/19)经胸腔镜确诊;4例为孤立性呼吸道乳头状瘤,15例为多发性呼吸道乳头状瘤。19例(19/19)病理组织学类型均为鳞状细胞乳头状瘤,病灶组织样本均进行HPV相关检测,2例HPV6/11型阴性,17例(17/19)阳性,其中单纯HPV6型(+)7例,单纯HPV11型(+)4例,HPV6/11型双重(+)6例;19例病灶组织HPV16/18型均为阴性。17例经支气管镜下介入治疗,其中15例复发,2例无复发;1例经胸腔镜行肺叶切除术,术后4个月死亡,1例放弃治疗。结论LRP临床少见,孤立LRP更少见,呈慢性病程,年幼起病常有上呼吸道受累,主要症状为咳嗽咳痰、呼吸困难、声嘶;胸部CT表现为结节肿块影、囊性薄壁空洞或气道阻塞征象,部分可强化;支气管镜下表现为乳头状肿物,确诊依靠病理学,以鳞状细胞乳头状瘤多见,其发病可能与低危型HPV感染相关;支气管镜下切除为主要治疗手段,易复发,治疗需兼顾上呼吸道病变,临床应重视针对HPV的病因治疗及预防。

Clinical features of 19 cases of lower respiratory papillomatosis

Objective To explore the clinical characteristics and prognosis of lower respiratory papilloma(LRP)and therefore to improve clinical diagnosis and treatment.Methods We performed a retrospective analysis of patients who were diagnosed with LRP in our department from October 2008 to October 2020.Results Nineteen patients were enrolled and 12 were male and 7 were female.The average age of the 7 adult patients was(41.3±17.5)years and that of the 12 pediatric patients was(5.5±3.5)years.Ten(83.3%)of the pediatric patients showed disease onset at an age of less than 5 years.The main symptoms were cough and sputum production(13/19),dyspnea(15/19),hoarseness(10/19)and signs of stridor or wheezing(7/19).Chest CT examination was performed in 9 patients,which showed nodules or masses(9/9),cystic thin-walled cavity(4/9),obstructive pneumonia(2/9),atelectasis(2/9),and spicule sign(1/9).The upper respiratory tract was affected in all the pediatric patients(12/12)and 3/7 of the adult patients.Eighteen cases(18/19)were diagnosed by bronchoscopy,1(1/9)by thoracoscopy.Eighteen cases(18/19)showed mulberry-like and papillary lesions under bronchoscopy.All the cases were histologically confirmed as squamous cell papilloma,with 17 cases(17/19)showing tissue HPV6/11(+),2 negative(2/19).The positive rate of HPV6 was 36.8%,ant that of HPV11 was 21.1%,while the double positive rate of HPV6/11 was 31.6%,and HPV16/18 were negative in all the 19 cases.Isolated respiratory papillomatosis was found in 4 cases(4/19),and multiple papillomatosis in 15 cases(15/19).Seventeen cases(17/19)underwent endoscopic interventional therapy,and the result showed that 15 cases relapsed,and 2 cases had no recurrence.One patient was treated with thoracoscopic lobectomy,and died 4 months after surgery.One patient gave up treatment.Conclusions LRP is a rare clinical disease with a chronic course,and isolated LRP is even rarer.Young patients often suffer from upper respiratory tract involvement,and the main symptoms are cough,sputum production,dyspnea and hoarseness.CT scanning showed nodules and masses,cystic thin-walled cavities or signs of airway obstruction.Bronchoscopy often demonstrates papillary lesions.The diagnosis depends on pathology,with squamous cell papilloma being the most common,and most tests are positive for HPV6/11.It is suggested that the incidence is associated with low-risk HPV infection.Endoscopic resection is the main treatment,which is prone to relapse.The treatment should take into account the pathological changes of upper respiratory tract,and the etiological treatment of HPV should be stressed.