CAJ | 학술논문

目的探讨幼年型复发性呼吸道乳头状瘤(juvenile onset recurrent respiratory papillomatosis,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24 h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例次出现轻度呼吸困难,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24 h缺氧改善后返回病房.28例患儿均安全度过148例次手术的围手术期.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.
목적 탐토유년형복발성호흡도유두상류(juvenile onset recurrent respiratory papillomatosis,JORRP)환인위수술기적안전성.방법 회고성분석28례10개월지7세JORRP환인148례차기관삽관전신마취수술적술전후조새정도분급평고、마취방법선택、수술조작화술후기도유호등처리요점.결과 109례차Ⅰ도혹Ⅱ도호흡곤난환인취의24 h내수술,정맥유도후일차삽관성공；39례차Ⅲ도혹Ⅳ도환인채취급진수술,흡입유도후기관삽관,35례차일차삽관성공,4례차이차삽관성공.129례차술후무호흡곤난；17례차출현경도호흡곤난,여이흡양후완해；2례차환인술후출현저양혈증재중증감호실감호24 h결양개선후반회병방.28례환인균안전도과148례차수술적위수술기.101차술후24h성시명현호전,35차잉유경도성시；3례기관절개환인분별재5차、4차화3차술후선택발출기관투관.19례복발환인술후수방2～5년,기중1례수방3년미견복발.1례환인술후후협착.미발생사망병례.결론 근거호흡곤난정도선택합괄적수술시궤화마취방법,술중자세조작이급술후기도적유효유호,능제고JORRP환인위수술기적안전성.
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,17 children 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 1st 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 respiratory papilloma.