幼年型复发性呼吸道乳头状瘤病肺部播散的临床特点及麻醉要点

doi:10.6040/j.issn.1671-7554.0.2024.0983

摘要/Abstract

摘要： 目的探讨幼年型复发性呼吸道乳头状瘤病(juvenile-onset recurrent respiratory papillomatosis, JORRP)肺部播散的临床特点及麻醉要点。方法回顾性分析2022年6月1日至2023年12月31日就诊于首都医科大学附属北京同仁医院的120例JORRP患儿临床病历资料,将肺部CT表现特殊征象者定义为肺部播散,比较肺部播散组与非肺部播散组间临床特征与全身麻醉差异。结果本研究中JORRP肺部播散的发生率为15.8%(19/120),影像表现为双肺散在大小不等结节及类圆形空洞。肺部播散组初次手术年龄小于无播散组［1.4(0.9~2.4)岁 vs. 2.7(1.7~4.7)岁］,总手术次数大于无播散组［32.0(19.0~46.0)次 vs. 13.0(4.0~24.0)次］,气管切开率、气管播散率、不典型增生发生率远高于非播散组(78.9% vs. 10.9%, 100.0% vs. 11.9%, 68.4% vs. 27.7%),术前肺炎发生率、手术时长、全身麻醉时长、麻醉恢复时长及ICU留观率差异均有统计学意义(P<0.05)。多因素Logistic回归分析示,初次发病年龄≤2.5岁、气管切开、不典型增生及较多的手术次数(OR>1,P<0.05)均是肺部播散的危险因素。结论 JORRP肺部播散患儿与一般JORRP患儿相比,初次手术年龄小、手术次数多、气管切开率高、术前肺炎发生率高、手术时长、全身麻醉及麻醉恢复时间长、ICU留观率高、预后较差。对初次发病年龄≤2.5岁、有气管切开史及病理出现不典型增生的JORRP患儿,应警惕乳头状瘤的肺内播散,定期行肺部CT筛查。

关键词: 幼年型复发性呼吸道乳头状瘤病, 人乳头瘤病毒, 气管播散, 肺部播散, 麻醉

Abstract: Objective To investigate the clinical features and anesthetic concerns of pulmonary dissemination in juvenile-onset recurrent respiratory papillomatosis(JORRP). Methods We retrospectively analysed the clinical medical records of 120 children with JORRP who attended Beijing Tongren Hospital, Capital Medical University, from 1 June 2022 to 31 December 2023, defined those who showed special signs on lung CT as pulmonary dissemination, and compared the differences in clinical features and general anesthetic concerns between the pulmonary dissemination group and the no-dissemination group. Results The incidence of JORRP pulmonary dissemination in this study was 15.8%(19/120), with imaging findings of scattered nodules of variable size and round cavities in the lungs. The age of initial surgery in the pulmonary dissemination group was younger than that in the no-dissemination group ［1.4(0.9-2.4)years vs. 2.7(1.7-4.7)years］, and the total number of surgeries was greater than that in the no-dissemination group ［32.0(19.0-46.0)times vs. 13.0(4.0-24.0)times］. The tracheotomy rate, the tracheal dissemination rate and the incidence of atypical hyperplasia in the pulmonary dissemination group were significantly higher than those in the no-dissemination group(78.9% vs. 10.9%, 100.0% vs. 11.9%, 68.4% vs. 27.7%). The differences in the incidence of preoperative pneumonia, duration of surgery, duration of general anesthesia, duration of recovery from anesthesia, and ICU retention rate were statistically significant(P<0.05). Multifactorial Logistic regression analysis showed that age at first presentation ≤2.5 years, tracheotomy, atypical hyperplasia and higher number of operations(OR>1, P<0.05)were risk factors for pulmonary dissemination. Multivariate Logistic regression analysis showed that age at onset≤2.5 years, tracheotomy, atypical hyperplasia and frequent surgery(OR>1, P<0.05)were risk factors for pulmonary dissemination. Conclusion Compared to general JORRP patients, JORRP patients with pulmonary dissemination have a younger initial age of surgery, more surgeries, a higher tracheotomy rate, a higher incidence of preoperative pneumonia, a longer operation and general anaesthesia time, a higher ICU observation rate and a poorer prognosis. Children with JORRP who have a history of tracheotomy and atypical hyperplasia with an initial age of onset ≤2.5 years should be alert for pulmonary dissemination of the papilloma and undergo regular lung CT screening.

Key words: Juvenile-onset recurrent respiratory papillomatosis, Human papilloma virus, Tracheal dissemination, Pulmonary dissemination, Anesthesia

中图分类号:

R762

石军,牛子捷,王军,马丽晶,奚春花,肖洋. 幼年型复发性呼吸道乳头状瘤病肺部播散的临床特点及麻醉要点[J]. 山东大学学报 (医学版), 2024, 62(12): 82-89.

SHI Jun, NIU Zijie, WANG Jun, MA Lijing, XI Chunhua, XIAO Yang. Clinical features and anesthetic concerns in pulmonary dissemination of juvenile-onset recurrent respiratory papillomatosis[J]. Journal of Shandong University (Health Sciences), 2024, 62(12): 82-89.

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