经口机器人手术治疗局部复发鼻咽癌的临床研究

Transoral robotic nasopharyngectomy for local recurrent nasopharyngeal carcinoma

目的探讨经口达芬奇机器人手术在局部复发性鼻咽癌切除中的安全性、有效性、肿瘤局部控制率及生存结果。方法回顾性分析2017年10月至2020年1月中山大学孙逸仙纪念医院耳鼻咽喉科采用经口进路,应用达芬奇手术系统进行局部复发鼻咽癌(rT1-2、部分rT3期)切除手术的33例患者的病例资料,其中男性20例,女性11例,年龄(47.9±10.5)岁。病变局限在鼻咽腔14例,累及咽旁间隙6例,累及蝶窦底13例。必要时手术联合使用经鼻鼻内镜技术。采用SPSS 25.0统计软件进行分析。结果所有病例完成经口机器人鼻咽切除术,无中转开放,其中联合经鼻鼻内镜手术13例。手术时间为(126.2±30.0)min,范围为90~180 min。术后病理切缘为R0者31例,R1者2例,无肉眼肿瘤残留。术后并发症以头痛、鼻腔干燥、腭咽功能不全等症状较为多见,无鼻咽大出血。术后随访时间为3~54个月,1例患者术后11个月手术邻近部位肿瘤复发,1例术后27个月出现同侧颈部淋巴结转移,2例出现远处转移,1例术后3个月死于鼻咽大出血。本组病例1年、2年、3年总生存率分别为97.0%、96.0%及92.9%,无局部复发率为97.0%、95.7%及91.7%。结论经口机器人鼻咽切除术治疗局部复发鼻咽癌安全、有效、可行,有较好的肿瘤局部控制率和生存率。

Objective To investigate the safety,efficacy,locally control and survival results of transoral Da Vinci robotic surgery for salvage treatment of locally recurrent nasopharyngeal carcinoma.Methods This retrospective study included 33 patients with locally recurrent nasopharyngeal carcinoma(stage rT1-2,partial rT3)underwent transoral Da Vinci robotic surgery between October 2017 and January 2020.There were 20 males and 11 females,with an average age of(47.9±10.5)years.The lesions were localized in nasopharyngeal cavity in 14 cases,with extending to parapharyngeal space in 6 cases and the floor of sphenoid sinus in 13 cases.Transnasal endoscopy was used to assist surgery if necessary.SPSS 25.0 statistical software was used for statistical analysis.Results Transoral robotic nasopharyngectomy was successfully performed in all cases without conversion to open surgery,of which 13 cases were combined with transnasal endoscopic surgery.The average operation time was(126.2±30.0)min,ranging from 90 to 180 min.The postoperative pathological margin was R0(31 cases)and R1(2 cases),with no tumor residue.Complications of surgery mainly included symptoms of headache,nasal dryness and velopharyngeal insufficiency without nasopharyngeal hemorrhage.Follow-up time was from 3 to 54 months.One case had tumor recurrence 11 months after operation,1 case had ipsilateral cervical lymph node metastasis 27 months after operation,2 cases had distant metastasis and 1 case died of nasopharyngeal hemorrhage 3 months after operation.The 1-year,2-year and 3-year overall survival rates were 97.0%,96.0%and 92.9%,respectively and the local recurrence free rates were 97.0%,95.7%and 91.7%,respectively.Conclusion Transoral robotic nasopharyngectomy is safe and feasible for local recurrent nasopharyngeal carcinoma in selected patients,with higher local control rate and quality of life.