Clinical Evaluation Of 35 Cases Of Recurrent Respiratory Papillomatosis

Papilloma of larynx has a highest morbility in the benign carcinoma of the larynx which origin from epithelium. It can happen in any stage of people. By now, most literature report that it is caused by human papilloma virus. Juvenile onset recurrent respiratory papillomatosis often grow faster, the tumor was big and multiple, has frequent recurrent rate. It often has the respiratory obstruction which can lead to death. Many evidences indicated HPV infecting children through vertical transmission. The reason why the adult suffer this disease is not sure. The adult patient has its own clinical character. The tumar often has long course but has more possibility of canceration. So it was considered as a kind of precancerous lesion.The etiopathogenisis and pathogenesy of RRP is not clear, and often recur after the treatment. So it induce heavy burden to family and the society. At present operation is still the main treatment of this disease, then take the adjunct treatment by the drugs such as INF, cidofovir and so on. But the adjunct treatment only can release the disease or prolong the time of recurrence. The individual variation also affect the results of the adjunct treatment. How many operation times of one patient suffered is the index of RRP morbidity. Many investigation show that many patient suffer fewer and fewer operations as the progress goes on. They considered it may not the effect of the adjunct drug but the course of the disease. So the pathogenesy, treatment and the course of the disease need more deep research.Our object is 35 papilloma patients who treat in our department from 1998 to 2007. all the patients was final diagnosised by the pathologic diagnosis. There is no abnormal of their laboratory examination and systemic disease. There are 16 adult patients. One of them get canceration. There are 9 patients who take the operation for more than 2 times. Recurrence rate is 56.25%. Canceration rate is 7.14%. There are 19 JORRP patients. 15 patients come to the hospital with the complaint of dyspnoea and hoarseness. They take operations for 52 times in all. There are 13 patients who have the operations for more than 2 times. The recurrence rate is 68.42%. We divide the adult into 2 groups according to the different kinds of operation, one is laryngofissure group and the other is laryngomicrosurgery with CO2 laser group. The JORRP patients were divided to 2 groups according to the laryngomicrosurgery with forceps and the laryngomicrosurgery with CO2 laser.We follow up the patients and record the recurrent time then analyze the data with the survival analysis to evaluate the effect of the treatment. We considered the recurrence as the failure event. We began record from the end of operation finishing with appearance of clinical symptom. The patient is regarded as a new one after receiving the treatment of recurrence. The patients who does not recurrent and lose following up were treated as the censored value. We analyse the data with long-rank test by SPSS 14.0 and form the survival curve.The result shows that the survival curves of laryngofissure and laryngomicrosurgery with CO2 laser were not across.χ2=7.702, P=0.006<0.05. There is ststistically significant difference between two groups. In adult group the laryngofissure is a more useful treatment for extending the recurrent time. The survival curves of laryngomicrosurgery with forceps and CO2 laser were not across.χ2=21.012, P=0.000<0.05. In JORRP group the laryngofissure with CO2 laser is a more useful treatment for extending the recurrent time.Most reports of the laser was limited in the treatment in the JORRP or put the adult patients and JORRP patients together, show the laser was more useful than the classical method however difference of age also have effect to the papillomatosis character. Our result of the adult group was different from the other report. The adult have more chance to infect the HPV16.18.33 which have more power of infestation the tumor is single and local. The laryngofissure can show more clear view of the extent of disease than the laryngomicrosurgery so it can remove the tumor more completely. Some research show that the gas created from the operation containing the HPV-DNA fragment which can induce the spreading and metastasis. So this shortage may have more negative influence in the treatment. Papillomatosis of the adult may have carcinomatous change so we should select the suitable treatment according to the patient's condition. All the JORRP patients we observed was treated by the laryngomicrosurgery but divided into forceps and CO2 laser group. And the result show that the CO2 laser is more useful to treat the RRP. The laser can kill the HPV without touch and carbonize the tissue so it can prevent the transmission.Conclusion: the adult patient of papillomatosis has the character of recurrence and canceration. The laryngofissure has more damage than laryngomicrosurgery. But our objective is reduce the rate of recurrence canceration and metastasis. So we can chose laryngofissure according to the pathogenetic condition and we also can use laryngofissure and laser together. The laser can extend the recurrence time when treating JORRP. But we should manage the skill to removal the tumor completely and extent the recurrent time.Papilloma of larynx is not a common ailment. All the research does not have enough case and different area have different morbidity. Not all the patient receive the normalize treatment. Recently fallowing the increase of condyloma acuminatum morbidity the morbidity of JORRP was also increase. But it have no radical cure up to now. Individual difference make the research have not enough evidence of the various kinds of adjunct treatment. So how we can manage the radical cure is still need more deeper research.