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Behandlungsergebnisse bei rezidivierender respiratorischer Papillomatose

Retrospektive Analyse juveniler und adulter Fälle

Treatment outcomes of recurrent respiratory papillomatosis

Retrospective analysis of juvenile and adult cases. German version

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Zusammenfassung

Hintergrund

Die rezidivierende respiratorische Papillomatose (RRP) ist eine seltene chronische Erkrankung viraler Ätiologie, die durch das multiple, rezidivierende Auftreten von Plattenepithelpapillomen charakterisiert ist.

Material und Methoden

Retrospektiv wurden die Behandlungsergebnisse und Rezidivraten von 106 Patienten mit RRP des Larynx ausgewertet. Sie wurden zwischen 1983 und 2014 wegen RRP an der Uniklinik Magdeburg behandelt. Verglichen wurden die konventionelle und Laserchirurgie bezüglich der Rezidivintervalle und der Komplikationen sowie der Effekt der Gardasil®-Impfung bei 10 Patienten.

Ergebnisse

Bei Kindern mit RRP erfolgten signifikant mehr Eingriffe lebenslang als bei erwachsenen Patienten. Es gab keine signifikanten Unterschiede in der Zeit bis zum Rezidiv oder in der Anzahl der Eingriffe/Jahr bei der adulten (n = 79) und bei der juvenilen (n = 27) RRP. Die verschiedenen chirurgischen Methoden hatten keinen Einfluss auf die Zeit bis zum Rezidiv oder die Anzahl der Eingriffe/Jahr. Komplikationen traten ohne signifikanten Unterschied sowohl nach konventioneller Chirurgie als auch nach Laserchirurgie auf. Ernste Komplikationen und die Notwendigkeit einer Tracheotomie wurden nur selten beobachtet. Durch die Gardasil®-Impfung wurde bei den 10 Patienten eine signifikante Reduktion der Eingriffe/Jahr nach der Impfung erreicht.

Schlussfolgerung

Die RRP ist eine seltene Krankheit. Die Behandlung benötigt Erfahrung und kann sehr schwierig sein. Nach Auswertung der Ergebnisse ist die Behandlung der Wahl die laserchirurgische Ablation der Papillomherde in Kombination mit der quadrivalenten bzw. polyvalenten Impfung. Möglicherweise kann durch eine konsequente Impfung sowohl von Mädchen als auch Jungen das Auftreten der RRP reduziert werden.

Abstract

Background

Recurrent respiratory papillomatosis (RRP) is a rare, chronic disease of viral etiology which is characterized by multiple, recurrent growth of papillomas in the aerodigestive tract.

Materials and methods

The surgical outcomes and the recurrence rates of 106 patients with RRP of the larynx were analyzed. The patients were treated at the University of Magdeburg between 1983 and 2014. The surgical outcomes of conventional and laser surgery regarding time to relapse and complications were compared. In addition, the influence of the quadrivalent vaccine Gardasil® on the disease was analyzed in 10 patients.

Results

Children with RRP had a statistically significant greater number of surgeries throughout their lifetimes compared to adult patients. There were no differences between the adult (n = 79) and juvenile (n = 27) groups in the time to relapse and the number of surgeries/year. The time to relapse and number of procedures/year were not influenced by the various surgical methods. Complications after conventional and laser surgery were not statistically different between the two groups. Serious complications and the need for a tracheotomy were only reported after conventional surgery. In the 10 patients who were immunized with Gardasil®, a statistically significant lower number of surgeries/year after vaccination was achieved.

Conclusion

RRP is a rare disease. Treatment requires experience and may be very difficult. The analysis of the course of the disease has shown that the treatment of choice is surgical excision with the CO2 laser combined with the quadrivalent or polyvalent vaccine. Consequent vaccination of both boys and girls has the potential to reduce the occurrence of RRP.

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Authors and Affiliations

  1. Universitäts-Hals-, Nasen- und Ohrenklinik, Universitätsklinikum Magdeburg AöR, Otto-von-Guericke-Universität Magdeburg, Leipziger Straße 44, 39120, Magdeburg, Deutschland

    V.-A. Papaioannou, S. Voigt-Zimmermann & C. Arens

  2. Institut für Biometrie und medizinische Informatik, Universitätsklinikum, Otto-von-Guericke-Universität, Magdeburg, Deutschland

    A. Lux

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  1. V.-A. Papaioannou
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Correspondence to V.-A. Papaioannou.

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Interessenkonflikt

V.-A. Papaioannou, A. Lux, S. Voigt-Zimmermann und C. Arens geben an, dass kein Interessenkonflikt besteht.

Alle Daten wurden retrospektiv und anonym erhoben. Nach Beratung mit unserer Ethikkommission war hier ein Ethikantrag nicht notwendig.

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Papaioannou, VA., Lux, A., Voigt-Zimmermann, S. et al. Behandlungsergebnisse bei rezidivierender respiratorischer Papillomatose. HNO 65, 923–932 (2017). https://doi.org/10.1007/s00106-017-0377-1

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