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.	蔣振華,王杰,董釧,等.CO₂激光扁桃體切除術的臨床研究[J].臨床耳鼻咽喉頭頸外科雜志,2010,24(3):119-121.
4.	郭潔波,張湘民,蘇振忠,等.內窺鏡結合支撐喉鏡在小兒喉乳頭狀瘤手術中的應用[J].中山大學學報·醫學科學版,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.	黃選兆,汪吉寶.實用耳鼻咽喉科學[M].北京:人民衛生出版社,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.兒童復發性喉乳頭狀瘤臨床治療探討[J].臨床耳鼻咽喉頭頸外科雜志,2009,23(11):503-505.
9.	王軍,韓德民,李秋珍,等.氣管內窺鏡在治療小兒復發性氣管內乳頭狀瘤中的應用[J].臨床耳鼻咽喉科雜志,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,李繼發.耳鼻咽喉部乳頭狀瘤[J].中華耳鼻咽喉科雜志,1986,16(4):24.
13.	費聲重,吳正虎.喉癌與人乳頭狀瘤病毒相關性研究的進展[J].中華耳鼻咽喉科雜志,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. 蔣振華,王杰,董釧,等.CO₂激光扁桃體切除術的臨床研究[J].臨床耳鼻咽喉頭頸外科雜志,2010,24(3):119-121.
4. 郭潔波,張湘民,蘇振忠,等.內窺鏡結合支撐喉鏡在小兒喉乳頭狀瘤手術中的應用[J].中山大學學報·醫學科學版,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. 黃選兆,汪吉寶.實用耳鼻咽喉科學[M].北京:人民衛生出版社,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.兒童復發性喉乳頭狀瘤臨床治療探討[J].臨床耳鼻咽喉頭頸外科雜志,2009,23(11):503-505.
9. 王軍,韓德民,李秋珍,等.氣管內窺鏡在治療小兒復發性氣管內乳頭狀瘤中的應用[J].臨床耳鼻咽喉科雜志,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,李繼發.耳鼻咽喉部乳頭狀瘤[J].中華耳鼻咽喉科雜志,1986,16(4):24.
13. 費聲重,吳正虎.喉癌與人乳頭狀瘤病毒相關性研究的進展[J].中華耳鼻咽喉科雜志,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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