摘要
目的探讨气管切开术对小儿复发性呼吸道乳头状瘤（juvenile onset recurrent respiratory papillomatosis, JRRP）远期疗效的影响。方法回顾性分析1993至2007年收治并基本完成治疗的JRRP患儿，将其分为气管切开组和常规手术组，对两组患儿的临床资料和回访记录进行回顾分析与对照研究。结果气管切开术组29例患儿带管时间为13．0-66．5个月，每例患儿肿瘤切除手术4-9次（中位数7次），拔管后2年以上无复发者27例，未拔管2例中气管切开后气管切口和支气管内肿瘤播散各1例，分别失访和死亡；未出现脱管、喉气管狭窄等严重并发症。常规手术对照组57例，每例患儿肿瘤切除术9-32次（中位数18次）。术后随访1年以上肿瘤无复发患儿53例；总气管内播散2例，行手术切除后2年内未见复发；支气管内播散的2例中1例失访，1例死亡；未见喉气管狭窄等严重并发症。气管切开术组患儿嗓音评估明显优于常规手术组，差异有统计学意义（X^2=33．16，P〈0．005）；肿瘤气管内播散率两组间差异无统计学意义（X^2=0．0026，P〉0．05）。结论气管切开术后可减少JRRP肿瘤切除手术的次数，保全嗓音功能，且未增加肿瘤气管内播散率。对于高复发性JRRP或随诊困难的患儿，气管切开术是一种行之有效的治疗方法，远期疗效优于反复手术者。
Objective To explore the long-term therapeutic effects of tracheotomy on juvenile onset recurrent respiratory papillomatosis in children. Methods Between 1993 and 2007, 86 cases of juvenile onset recurrent respiratory papillomatosis （JRRP） in children were encounted and divided into tracheotomy group and conventional surgery group, the clinical data of these children were retrospectively analyzed. Results There were 29 cases in tracheotomy group, the time of carrying tracheal casing pipe was 13 -66.5 months, the operative times of every case was 4 - 9 times （ median 7） , there were 27 cases with more than 2 years release after extubation. There were 2 cases with tumor dissemimateion into incision of trachea and endotracheal, one case lost to follow up and the other one dead. No case developed laryngotracheal stenosis and severe complication. There were 57 cases in conventional surgery group, the operation times of every case was 9 -32 times （median 18）. Fifty-three cases with no recurrence after follow up for more than one year; 2 cases with trachea tumor disseminateion, and after operation, no.recurrence after 2 years follow up. Two cases with endotracheal disseminateion, one case lost to follow up and the other one dead. No case developed laryngotracheal stenosis and severe complication. The voice assessment result of tracheotomy group was obviously better than that in the conventional surgery group, the disparation had statistical significance （X^2 =33.16, P 〈0. 005）, the tumor disseminateion rate of the two groups had no statistical significance （ X^2 = 0. 0026, P 〉 0.05 ）. Conclusions Tracheotomy significantly reduce the operative times, give the greatest degree of preservation of laryngeal function, and it do not increase the tumor disseminateion into trachea. Tracheotomy is an effective method of treatment in children with a high rate of recurrence, and with poor economic conditions, and difficult to follow-up. It can improve the long-term life quality of the children.
出处
《中华耳鼻咽喉头颈外科杂志》
CAS
CSCD
北大核心
2012年第12期969-973,共5页
Chinese Journal of Otorhinolaryngology Head and Neck Surgery
