幼年型复发性呼吸道乳头状瘤围手术期处理体会  

Peri-operative management on juvenile recurrent respiratory papillomatosis

作　　者：南奔宇[1] 陈波蓓[1] 张初琴[1] 陈迎迎[1] 高金建[1] 张旭彤 万汉锋[1] 章誉耀[1] 项海杰[1] 

机构地区：[1]温州医学院附属第二医院附属育英儿童医院耳鼻咽喉科,325027 [2]麻醉科

出　　处：《中华耳鼻咽喉头颈外科杂志》2012年第6期454-457,共4页Chinese Journal of Otorhinolaryngology Head and Neck Surgery

基　　金：温州市科技局对外合作项目（H20070039）

摘　　要：目的探讨幼年型复发性呼吸道乳头状瘤（juvenile onset recurrent respiratorypapillomatosis, JORRP）患儿围手术期的安全性。方法回顾性分析28例10个月至7岁JORRP患儿148例次气管插管全身麻醉手术的术前喉阻塞程度分级评估、麻醉方法选择、手术操作和术后气道维护等处理要点。结果109例次I度或Ⅱ度呼吸困难患儿就医24h内手术，静脉诱导后一次插管成功；39例次Ⅲ度或Ⅳ度患儿采取急诊手术，吸入诱导后气管插管，35例次一次插管成功，4例次二次插管成功。129例次术后无呼吸困难；17例次…现轻度呼吸困难，予以吸氧后缓解；2例次患儿术后出现低氧血症在重症监护室监护24h缺氧改善后返回病房。28例患儿均安全度过148例次手术的同手术期。101次术后24h声嘶明显好转，35次仍有轻度声嘶；3例气管切开患儿分别在5次、4次和3次术后选择拔出气管套管。19例复发患儿术后随访2—5年，其中1例随访3年未见复发。1例患儿术后喉狭窄。未发生死亡病例。结论根据呼吸困难程度选择合适的手术时机和麻醉方法，术中仔细操作以及术后气道的有效维护．能提高JORRP患儿围手术期的安全性。Objective To investigate the safety of peri-operative management on children with juvenile recurrent respiratory papilloma （JORRP）. Methods A retrospective analysis was conducted on preoperative assessment, anesthesia methods and options, operative procedure, and postoperative airway maintenance in 28 JORRP children aged from ten months to seven years old. A total of 148 times of surgery was performed on these 28 children. Results One hundred and nine JORRP children graded one and two- degree dyspnea underwent surgery within 24 hours and were intubated successfully in the first attempt after intravenous induction. Thirty-nine emergency operations were performed in the children graded three and four-degree dyspnea, 35 of them were intubated successfully in the first attempt after inhalation induction and 4 succeeded in the second attempt. No complications occurred in 129 JORRP children postoperatively, 17children suffered from mild dyspnea and relieved after oxygen inhalation, 2 children were intubated and sent to intensive care unit because of postoperative hypoxemia. All JORRP children got through the peri-operative period safely. The quality of pronunciation in 101 children improved markedly and 35 suffered from slight hoarseness on the l st postoperative day. Three children had the tracheal tube of tracheostomy removed after receiving five, four and three operations respectively. Nineteen children were followed up for 2 - 5 years. Among them, one child did not relapse 3 years after surgical management. One child suffered from laryngostenosis postoperatively. No death occurred. Conclusion Complete preoperative preparation, rational anesthesia methods, careful operative procedure and airway maintenance ＇after surgery could increase the safety for children with recurrent respiratol7 papilloma.

关 键 词：乳头状瘤 喉肿瘤 儿童 呼吸困难 手术期间 

分 类 号：R739.65[医药卫生—肿瘤]