摘要目的 分析CO2激光结合显微电动吸切器治疗重症幼年型复发性呼吸道乳头状瘤(juvenile on-set recurrent respiratory papillomatosis,JORRP)患儿的疗效、预后及并发症.方法 回顾性分析2002-2013年北京同仁医院收治的全部JORRP患儿495例,纳入肿瘤生长多发成簇,有喉气管多个区域受累,且复发频率较高,诊治期间需1年手术4次或以上经历的49例患儿.49例患儿首诊年龄中位数2[1;3]岁.首诊症状嘶哑7例,呼吸困难42例.肿瘤累及声门下或气管者占53.0％.患儿均应用CO2激光结合显微电动吸切器治疗.分析患儿病情特点、肿瘤累及区域、气管切开情况、喉部及肺部并发症情况、手术方法、手术频次及间隔、疗效及预后情况.用秩和检验分析非正态分布的计量资料间的差异性,卡方检验比较两个率之间的差异.结果 49例患儿随访39 ～ 185个月,中位数99.0[74.5;121.0]个月.49例中29例(59.1％)病情明显缓解,其中8例(16.3％)近3年内无复发(治愈).在无气管切开的36例患儿中,25例明显缓解,其中7例近3年内无复发.气管切开患儿13例,7例(53.8％)患儿拔管成功.3例死亡患儿均为乳头状瘤生长累及支气管、肺部.结论 重症JORRP患儿发病年龄小,气道狭小,临床症状重,喉显微电动吸切器与CO2激光联合应用治疗JORRP使手术更加准确、迅速,降低手术风险,减少并发症,部分患者可成功拔管.

abstractsObjective Juvenile on-set recurrent respiratory papillomatosis (JORRP) can be an aggressive and potentially life-threatening disease.To emphasize the importance of complication prevention in local excision surgery,the single-center experience of RRP treatment in a group of patients with relatively short recurrence-free-interval (＞ 4 times/yrs) was reported.Methods Data of 49 patients underwent papilloma resection during 2002-2013 were retrospectively analyzed.Combined techniques of laser microsurgery and microdebriders were used to remove papillomas,prevent the formation of scar tissue and improve respiratory distress.Forty-nine cases were followed up for 99.0[74.5;121.0] months,ranging from 39 to 185 months.The age of disease onset was 2[1;3] years old.Most of the patients had difficulty in breathing(42 of 49 cases).Seven patients had hoarseness.53.0％ patients had subglottic or trachea papillomatosis spreading.The rate of complications,synechia formation,tracheal stenosis,needing for tracheostomy,mortality was recorded.Patients were followed up for at least three years.The characteristics of the patients,improvement in symptoms,recurrence-free interval,and the rate of tracheal extubation were evaluated.Wilcoxon signed ranks test and chi-square test were used for data comparation.Results Longterm relieve in disease (≤2 surgeries were needed/year) were achieved in 29 (59.1％) subjects,in which 8(16.3％) of the subjects did not need surgical treatment for at least 3 years.Long-term relieve had been achieved in 25 of subjects who did not accept tracheostomy.Seven subjects did not need surgical treatment for at least 3 years.The rate of successful tracheal extubation was 53.8％ in 13 patients who had undergone tracheostomy.Three cases dead of intrapulmonary spread.Conclusions Combined techniques of laser microsurgery and microdebriders are effective in improvement in both respiratory distress and voice quality.The combined technique are helpful to avoid inevitable long-term stenotic complications,ultimately affecting the quality of life.