Analysis of related factors of postoperative complications of Juvenile-onset recurrent respiratory papillomatosis
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摘要: 目的 分析幼年型复发性呼吸道乳头状瘤(JORRP)术后并发症形成的原因和相关因素。 方法 对2017－2019年于首都医科大学附属北京同仁医院行手术治疗的170例JORRP患儿进行随访，并回顾性分析患儿的临床资料，记录性别、发病年龄、病灶位置、临床表现、手术方式、气管切开术史、组织病理学结果、手术次数、手术间隔、术后并发症等情况。根据有无术后并发症将患儿分为并发症组和对照组，比较两组间的差异及引起术后并发症的相关因素。 结果 170例患儿中，75例(44.12%)患儿出现术后并发症，并发症组中声带粘连52例(69.33%)、下气道播散37例(49.33%)、喉狭窄25例(33.33%)。初次手术年龄为0.3~14岁，平均总手术次数14.52(1~54)次，平均年手术次数2.93(0.04~18.39)次。并发症组和对照组总手术次数分别为(19.07±13.12)次和(10.97±9.41)次(P < 0.01)。年手术次数≥4次(P = 0.034)、气管切开后(P = 0.007)、经历过低温等离子射频消融手术和和光动力治疗较单纯使用CO2激光(P < 0.01)的患儿更易出现术后并发症。 结论 JORRP术后并发症包括声带粘连、喉气管狭窄、下气道播散等。多次、频繁的手术和气管切开、不同的手术方式与术后并发症密切相关。患儿初次手术年龄较小、年手术次数较多时可能增加术后并发症的风险。Abstract: Objective To analyze the causes and related factors of postoperative complications of Juvenile-onset recurrent respiratory papillomatosis(JORRP). Methods One hundred and seventy cases of JORRP who underwent surgical treatment in Beijing Tongren Hospital of Capital Medical University from 2017 to 2019 were followed up, and the types of complications, age of first operation, number and frequency of operations, and underwent tracheotomy or not were reviewed. According to the presence or absence of postoperative complications, the patients were divided into a complication group and a control group, and the differences between the two groups and related factors causing postoperative complications were compared. Results In the 170 cases, 75(44.12%) had postoperative complications, including 52(69.33%) cases of vocal cord adhesion, 37(49.33%) cases of lower airway diffusion, and 25(33.33%) cases of laryngeal stenosis in the complication group. The age of first operation was among 0.3-14 years old, and the total number of surgeries was 14.52(1-54) for each patient during the observation period, with an average annual number of 2.93(0.04-18.39). Compared with the control group, the complication group had 19.07±13.12 total surgeries, the control group had 10.97±9.41 surgeries(P < 0.01), annual surgeries ≥4 times(P = 0.034), postoperative complications after tracheotomy(P = 0.007), and underwent low temperature plasma radiofrequency ablation and photodynamic therapy were more likely to occur than those treated with CO2laser only(P < 0.01). Conclusion The postoperative complications of JORRP include vocal cord adhesion, laryngotracheal stenosis, lower airway dissemination, etc. Multiple and frequent operations, tracheotomy, and different surgical methods are closely related to postoperative complications. The risk of postoperative complications may be increased when children are younger in age of initial operation and with more frequency of surgeries.
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表 1 并发症组与对照组相关因素比较
指标 并发症组(n＝75) 对照组(n＝95) P 初次手术年龄/岁 3.04 3.10 < 0.01 每年手术频率/次 ≥4 21 14 < 0.05 < 4 54 81 气管切开 是 27 17 < 0.01 否 48 78 手术方式 单纯使用CO2激光 55 89 < 0.01 曾行射频手术等其他治疗 20 6 
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