复发性呼吸道乳头状瘤（RRP）是一种少见的良性疾病，由人乳头瘤病毒（HPV）引起，可分为儿童和成人形式。疾病的进展是不确定的，但在儿童形式中通常更为侵袭性。标准的手术治疗方法是CO2激光切除术，尽管光动力血管松解激光也是一种有效的替代方法。在需要频繁手术切除或病变扩散至下呼吸道的情况下，已提出辅助治疗方法来控制疾病。近年来，免疫治疗的发展使得贝伐单抗在肿瘤内注射或静脉注射的应用成为可能，但最有希望的治疗方法仍然是人乳头瘤病毒疫苗免疫接种。本文旨在介绍RRP治疗领域的文献综述和三个不同大学中心的经验。我们对2002年至2022年期间在三个不同大学中心接受治疗的喉乳头状瘤患者的临床资料进行了回顾性分析。收集了以下参数：性别、首次评估时的年龄、喉部病变部位、HPV类型、首次手术治疗类型、复发的存在和次数、复发的手术治疗、辅助治疗、副作用以及最后随访时的状况。共有78名患者可供评估。其中，88%的患者患有成人起病型RRP（Ao-RRP），12%的患者患有儿童起病型RRP（Jo-RRP）。声门是最常受累的部位；所有患者均接受了全麻下的CO2激光手术切除。复发发生在79%的患者中，未复发的患者均为成人。平均复发次数为9次（范围1-110次）。儿童复发次数较多（M=20次；范围2-110次），而成人复发次数较少（M=5次；范围1-21次）。62名复发患者中，32人（52%）选择再次接受全麻下的CO2激光手术切除，而其余30人（48%）选择办公室内使用光动力血管松解激光进行治疗。26名患者接受了辅助治疗。对疾病进程的分析显示，对于9名Jo-RRP患者，有6人（67%）在最后随访时无病灶，而另外3人（33%）出现了乳头状瘤。对于69名Ao-RRP患者，53人（77%）在最后一次访问时存活并无疾病，14人（21%）存活但有疾病，1人（1%）随访时失访，1人（1%）死于其他疾病。除了2名患者出现后声门狭窄外，我们没有观察到严重的副作用。我们的研究结果与文献综述相一致。RRP是一种潜在侵袭性疾病，特别是儿童起病型。手术切除仍然是一线治疗，但在多次复发的情况下，应考虑使用辅助治疗。版权所有© 2023罗马意大利意大利耳鼻喉头颈外科学会。

Recurrent respiratory papillomatosis (RRP) is a benign, rare disease caused by Human Papilloma Virus (HPV) that can be divided into juvenile and adult forms. The course of the disease is variable, but is usually more aggressive in the juvenile form. The standard surgical treatment is represented by CO2 laser resection, although photoangiolytic lasers represent a valid alternative. Adjuvant therapies have been proposed for disease control in case of frequent surgical resections or spreading into the lower airways. In recent years, the development of immunotherapy led to the use of bevacizumab either intratumorally or intravenously, but the most promising therapeutic development is represented by HPV vaccination. This paper aims to present a narrative review of the literature and the experience of three different University Centres in the treatment of RRP.A retrospective analysis of the clinical charts of all patients affected by laryngeal papillomatosis and treated in three different University Centres between 2002 and 2022 was performed. The following parameters were collected: sex, age at first evaluation, sites of larynx involved, HPV type, type of first surgical treatment, presence and number of recurrences, surgical treatment of recurrences, adjuvant therapies, side effects and status at last follow-up.Seventy-eight patients were available for evaluation. Of these, 88% had adult onset RRP (Ao-RRP) and 12% juvenile onset RRP (Jo-RRP). The glottis was the most frequently involved subsite; all patients were submitted to surgical resection with CO2 laser under general anaesthesia. Recurrences appeared in 79% of the patients, the patients who did not recur were all adults. The mean number of recurrences was 9 (range 1-110). Recurrences were more frequent in children (M = 20; range 2-110) than adults (M = 5; range 1-21). Thirty-two (52%) of the 62 patients who recurred were re-treated with CO2 laser under general anaesthesia, while office-based treatment with a photoangiolytic laser was preferred in the remaining 30 (48%) patients. Adjuvant treatments were applied in 26 patients. The analysis of the course of the disease showed that in the 9 patients with Jo-RRP, 6 (67%) were free of lesions at the last follow-up, while the other 3 (33%) had papillomas. Of the 69 patients with Ao-RRP, 53 (77%) were alive and free of disease at the last visit, 14 (21%) were alive with disease, 1 (1%) was lost at follow-up and 1 (1%) died for other disease. Severe side effects were not observed except for 2 patients, who developed posterior glottic stenosis.Our results confirmed the literature review. RRP is a potentially aggressive disease, especially in juvenile onset. Surgical resection is still first-line treatment, but in case of multiple recurrences the use of adjuvant therapies must be taken into consideration.Copyright © 2023 Società Italiana di Otorinolaringoiatria e Chirurgia Cervico-Facciale, Rome, Italy.