Clinical Study of Carbon Dioxide Laser in Treating Laryngeal Papilloma_West China Medical Journal

Authors：

 JIANGZheng-hua ,  LIUGuo-qi , WANGJie , DONGChuan , XURan , ZHANGZhen

Department of Otolaryngology Head and Neck Surgery, Mianyang Central Hospital, Mianyang, Sichuan 621000, P. R. China;

Corresponding author：

LIUGuo-qi, Email: sousudao@sina.com

Keywords：

Carbon dioxide laser; Laryngeal papilloma; Recurrence

DOI：

10.7507/1002-0179.20140512

Video：

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Objective To investigate the clinical efficacy of carbon dioxide (CO₂) laser ablation in the treatment of laryngeal papilloma and analyze the relevant factors for recurrence. Methods We retrospectively analyzed the clinical data of 102 patients with laryngeal papilloma treated between February 2003 and October 2010 in our department. They were divided into the juvenile group (n=70) and adult group (n=32). Patients in both groups underwent microsurgery with CO₂ laser ablation to remove the lesions under general anesthesia. During the process, we observed patients'site of lesions, recurrence time, the incidence of postoperative vocal adhesions, and the occurrence of malignancy. Results All patients were followed up for 1 to 8 years. Eleven cases of vocal cord adhesion occurred, and patients with the adhesion all had former joint lesions, which accounted for 27.5% of all the anterior commissure adhesion patients. Four cases of malignancy all occurred in adults with an adult malignancy rate of 12.5%. Recurrence occurred in 41 cases and 76 cases of times, including 5 times in 2 cases, 4 times in 4 cases, 3 times in 3 cases, twice in 9 cases, and once in 23 cases. The difference in times of recurrence was significant between the juvenile and the adult group (P<0.05). Significant difference was found between single lesion and multiple lesion recurrence in both groups (P<0.05). There was no significant difference between the two groups in terms of single lesion recurrence (P>0.05), while the difference in multiple lesion occurrence was significant (P<0.05). The first recurrence time was within 12 months after surgery in both groups, and recurrence mainly occurred within 6 months after surgery. Single lesion and multiple lesion recurrence mainly manifested as anterior commissure lesions (2/3, 66.7%) and subglottic lesions (5/6, 83.3%) respectively. Conclusion Micro-laryngoscopy CO₂ laser laryngeal papilloma resection is safe, effective, and minimally invasive in the treatment of laryngeal papilloma, and is the preferred surgical method in clinic, but it still needs further improvement.

Citation： JIANGZheng-hua, LIUGuo-qi, WANGJie, DONGChuan, XURan, ZHANGZhen. Clinical Study of Carbon Dioxide Laser in Treating Laryngeal Papilloma. West China Medical Journal, 2014, 29(9): 1678-1681. doi: 10.7507/1002-0179.20140512 Copy

1.	Green GE,Bauman NM,Smith RJ.Pathogenesis and treatment of juvenile onset recurrent respiratory papillomatosis[J].Otolaryngol Clin North Am,2000,33(1):187-207.
2.	Sakoh T,Fukuda H,Sasaki S,et al.Laryngomicrosurgery with carbon dioxide laser for laryngeal papillomatosis:application of a two-stage operation[J].Auris Nasus Larynx,2005,20(3):223-229.
3.	蒋振华,王杰,董钏,等.CO₂激光扁桃体切除术的临床研究[J].临床耳鼻咽喉头颈外科杂志,2010,24(3):119-121.
4.	郭洁波,张湘民,苏振忠,等.内窥镜结合支撑喉镜在小儿喉乳头状瘤手术中的应用[J].中山大学学报·医学科学版,2003,24(2):175-177.
5.	Zacharisen MC,Conley SF.Recurrent respiratory papiilomatosis in children:masquerader ofcommon respiratory diseases[J].Pediatrics,2006,118(5):1925-1931.
6.	黄选兆,汪吉宝.实用耳鼻咽喉科学[M].北京:人民卫生出版社,1998:498-499.
7.	Kashima HK,Shah F,Lyles A,et al.A comparison of risk factors in juvenile-onset and adult-onset recurrent respiratory papillomatosis[J].Laryngoscope,1992,102(1):9-13.
8.	周非,李友忠,宋桂林,等.儿童复发性喉乳头状瘤临床治疗探讨[J].临床耳鼻咽喉头颈外科杂志,2009,23(11):503-505.
9.	王军,韩德民,李秋珍,等.气管内窥镜在治疗小儿复发性气管内乳头状瘤中的应用[J].临床耳鼻咽喉科杂志,2002,16(3):117,119.
10.	El-Bitar MA,Zalzal GH.Powered instrumentation in the treatment of recurrent respiratory papillomatosis:an alternative to the Carbon dioxide laser[J].Arch Otolaryngol Head Neck Surg,2002,128(4):425-428.
11.	Bjork H,Teir H.Benign and malignant papilloma of the larynx in adults; a comparative clinical and histological study[J].Acta Otolarynol,1957,47(2):95-104.
12.	倪合世,李继发.耳鼻咽喉部乳头状瘤[J].中华耳鼻咽喉科杂志,1986,16(4):24.
13.	费声重,吴正虎.喉癌与人乳头状瘤病毒相关性研究的进展[J].中华耳鼻咽喉科杂志,1995,30(2):115-118.
14.	López Amado M,García Caballero T,Lozano Ramírez A,et al.The detection of human papillomavirus in papillomas of the larynx and tonsils through immunohistochemistry and DNA in situ hybridization[J].Ann Otorhinolaryngol Ibero Am,1997,24(3):269-280.
15.	Silverman D,Pitman MJ.Current diagnostic and management trends for recurrent respiratory papillomatosis[J].Curr Opin Otolaryngol Head Neck Surg,2004,12(6):532-537.

1. Green GE,Bauman NM,Smith RJ.Pathogenesis and treatment of juvenile onset recurrent respiratory papillomatosis[J].Otolaryngol Clin North Am,2000,33(1):187-207.
2. Sakoh T,Fukuda H,Sasaki S,et al.Laryngomicrosurgery with carbon dioxide laser for laryngeal papillomatosis:application of a two-stage operation[J].Auris Nasus Larynx,2005,20(3):223-229.
3. 蒋振华,王杰,董钏,等.CO₂激光扁桃体切除术的临床研究[J].临床耳鼻咽喉头颈外科杂志,2010,24(3):119-121.
4. 郭洁波,张湘民,苏振忠,等.内窥镜结合支撑喉镜在小儿喉乳头状瘤手术中的应用[J].中山大学学报·医学科学版,2003,24(2):175-177.
5. Zacharisen MC,Conley SF.Recurrent respiratory papiilomatosis in children:masquerader ofcommon respiratory diseases[J].Pediatrics,2006,118(5):1925-1931.
6. 黄选兆,汪吉宝.实用耳鼻咽喉科学[M].北京:人民卫生出版社,1998:498-499.
7. Kashima HK,Shah F,Lyles A,et al.A comparison of risk factors in juvenile-onset and adult-onset recurrent respiratory papillomatosis[J].Laryngoscope,1992,102(1):9-13.
8. 周非,李友忠,宋桂林,等.儿童复发性喉乳头状瘤临床治疗探讨[J].临床耳鼻咽喉头颈外科杂志,2009,23(11):503-505.
9. 王军,韩德民,李秋珍,等.气管内窥镜在治疗小儿复发性气管内乳头状瘤中的应用[J].临床耳鼻咽喉科杂志,2002,16(3):117,119.
10. El-Bitar MA,Zalzal GH.Powered instrumentation in the treatment of recurrent respiratory papillomatosis:an alternative to the Carbon dioxide laser[J].Arch Otolaryngol Head Neck Surg,2002,128(4):425-428.
11. Bjork H,Teir H.Benign and malignant papilloma of the larynx in adults; a comparative clinical and histological study[J].Acta Otolarynol,1957,47(2):95-104.
12. 倪合世,李继发.耳鼻咽喉部乳头状瘤[J].中华耳鼻咽喉科杂志,1986,16(4):24.
13. 费声重,吴正虎.喉癌与人乳头状瘤病毒相关性研究的进展[J].中华耳鼻咽喉科杂志,1995,30(2):115-118.
14. López Amado M,García Caballero T,Lozano Ramírez A,et al.The detection of human papillomavirus in papillomas of the larynx and tonsils through immunohistochemistry and DNA in situ hybridization[J].Ann Otorhinolaryngol Ibero Am,1997,24(3):269-280.
15. Silverman D,Pitman MJ.Current diagnostic and management trends for recurrent respiratory papillomatosis[J].Curr Opin Otolaryngol Head Neck Surg,2004,12(6):532-537.

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Clinical Study of Carbon Dioxide Laser in Treating Laryngeal Papilloma

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