摘要
目的初步探讨经口入路机器人手术(transoral robotic surgery,TORS)治疗口咽癌的安全性及有效性。方法回顾性分析2017年3月至2018年10月期间在华中科技大学同济医学院附属同济医院使用达芬奇机器人经口入路进行的12例口咽癌患者的临床资料,其中扁桃体癌6例、舌根癌5例、口咽后壁癌1例。并分析患者手术时间、术中出血量,术后局部有无出血、呼吸困难、神经功能损伤,经口进食时间,是否行放化疗等各项指标。结果本组12例口咽癌患者,均在达芬奇机器人辅助下经口入路顺利切除,平均手术时间34.2 min(25~80 min),TORS手术平均出血量20.8 ml(10~50 ml),平均恢复经口进食时间8.4 d(1~30 d)。所有患者术中术后均未行气管切开术,术后均未出现气道梗阻、术后出血、神经功能受损症状。全部患者均经病理学证实达到切缘阴性。术后对T3以上或N2以上的患者均建议放疗或放化疗。术后随访4~22个月,中位随访时间12个月,未见局部复发或远处转移病例。结论在掌握好适应证的前提下,使用达芬奇机器人经口入路切除口咽癌,安全、有效、损伤小。
Objective To evaluate the indication,safety and effectiveness of transoral robotic surgery(TORS)for oropharyngeal cancer based on our preliminary experience.Methods Twelve patients,including six with tonsil cancer,five with tongue base cancer and one with posterior pharyngeal wall cancer,who underwent TORS with Da Vinci Si surgical system from March 2017 to October 2018 at Tongji Hospital of Huazhong University of Science Technology were respectively analyzed.And the surgical time,intraoperative blood loss,postoperative local bleeding,dyspnea,nerve function injury,oral intake time,whether or not to receive chemoradiotherapy were analyzed.Results All tumors in the 12 patients were en bloc removed by TORS.Surgical time ranged from 25 to 80 min with an average of 34.2 min.The blood loss ranged from 10 ml to 50 ml with an average of 20.8 ml.The recovery time for oral intake ranged from 1 day to 30 days with an average of 8.4 days.No patient underwent tracheostomy after TORS.Also,no patient manifested with airway obstruction,bleeding or nerve injury symptoms after operation.All 12 patients reached pathologically negative surgical margins.The patients were followed up for 4 to 22 months,with a median of 12 months.All patients who combined with more advanced than T3 stage,or more advanced than N2 stage were recommended to oncologist,then,followed with radiotherapy or chemoradiotherapy if no relevant contradictions occurred.No local recurrence or distant metastasis case was found.Conclusion With proper indications,the application of TORS in oropharyngeal cancer is a relatively safe,effective and minimal invasive therapy,which merits more clinical applications.
作者
徐凯
蔡兰军
陈红
李媛媛
王志斌
黄红彦
褚汉启
崔永华
刘争
陆翔
Xu Kai;Cai Lanjun;Chen Hong;Li Yuanyuan;Wang Zhibin;Huang Hongyan;Chu Hanqi;Cui Yonghua;Liu Zheng;Lu Xiang(Department of Otorhinolaryngology Head and Neck Surgery,Tongji Hospital,Tongji Medicdl College,Huazhong University of Science and Technology,Wuhan 430030,China;Department of Operation,Tongji Hospital,Tongji Medical College,Huazhong Unirersity of Science and Technology,Wuhan 430030,China)
出处
《中华耳鼻咽喉头颈外科杂志》
CAS
CSCD
北大核心
2020年第2期109-115,共7页
Chinese Journal of Otorhinolaryngology Head and Neck Surgery
基金
国家自然科学基金(81702687、81670911)。
关键词
达芬奇机器人手术系统
经口机器人手术
口咽癌
微创外科
Da Vinci robotic surgery system
Transoral robotic surgery
Oropharyngeal cancer
Minimal invasive surgery
