Clinical features and anesthetic concerns in pulmonary dissemination of juvenile-onset recurrent respiratory papillomatosis
Objective To investigate the clinical features and anesthetic concerns of pulmonary dissemination in juven-ile-onset recurrent respiratory papillomatosis(JORRP).Methods We retrospectively analysed the clinical medical records of 120 children with JORRP who attended Beijing Tongren Hospital,Capital Medical University,from 1 June 2022 to 31 December 2023,defined those who showed special signs on lung CT as pulmonary dissemination,and com-pared the differences in clinical features and general anesthetic concerns between the pulmonary dissemination group and the no-dissemination group.Results The incidence of JORRP pulmonary dissemination in this study was 15.8%(19/120),with imaging findings of scattered nodules of variable size and round cavities in the lungs.The age of initial sur-gery in the pulmonary dissemination group was younger than that in the no-dissemination group[1.4(0.9-2.4)years vs.2.7(1.7-4.7)years],and the total number of surgeries was greater than that in the no-dissemination group[32.0(19.0-46.0)times vs.13.0(4.0-24.0)times].The tracheotomy rate,the tracheal dissemination rate and the incidence of atypical hyperplasia in the pulmonary dissemination group were significantly higher than those in the no-dissemination group(78.9%vs.10.9%,100.0%vs.11.9%,68.4%vs.27.7%).The differences in the incidence of preoperative pneumonia,duration of surgery,duration of general anesthesia,duration of recovery from anesthesia,and ICU reten-tion rate were statistically significant(P<0.05).Multifactorial Logistic regression analysis showed that age at first pres-entation≤2.5 years,tracheotomy,atypical hyperplasia and higher number of operations(OR>1,P<0.05)were risk factors for pulmonary dissemination.Multivariate Logistic regression analysis showed that age at onset≤2.5 years,tracheotomy,atypicalhyperplasia and frequent surgery(OR>1,P<0.05)were risk factors for pulmonary dissemination.Conclusion Compared to general JORRP patients,JORRP patients with pulmonary dissemination have a younger ini-tial age of surgery,more surgeries,a higher tracheotomy rate,a higher incidence of preoperative pneumonia,a longer operation and general anaesthesia time,a higher ICU observation rate and a poorer prognosis.Children with JORRP who have a history of tracheotomy and atypical hyperplasia with an initial age of onset≤2.5 years should be alert for pulmo-nary dissemination of the papilloma and undergo regular lung CT screening.
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