单中心经口入路机器人手术治疗咽喉部病变的安全性及有效性

Safety and efficacy of single-center transoral robotic surgery forpharyngeal and laryngeal lesions

目的 对经口机器人手术(TORS)在治疗咽喉部病变中的安全性及有效性进行探讨。方法 回顾性分析2016年至2018年南京鼓楼医院行TORS治疗咽喉头颈部病变的9例患者的临床资料,其中口咽肿瘤6例,咽旁间隙肿瘤3例。分析患者的手术时间、术中出血量、术后禁食时间、术后住院天数、手术前后疼痛与吞咽困难评分、术后有无出血及神经损伤等并发症。结果 9例患者均通过TORS完成病灶切除。术后病理良性3例,恶性6例,所有切缘均为阴性。TORS手术时间为55~140(85.56±28.77)min,出血量为10~50(23.33±11.73)mL,术后住院天数为4~7(6.00±1.00)d,恢复饮食时间为1~3(1.78±0.67)d。除1名口咽癌患者术后当天出现伤口渗血,其余均未出现并发症。术后随访4~86个月,肿瘤患者无局部复发、远处转移或死亡。结论 依据本中心现有病例经验,合理选择适应证、手术方式,做好围手术期管理、术后长期随访,在一定程度上可以证实,TORS切除咽喉部病变是安全、有效的。

Objective To explore the safety and effectiveness of transoral robotic surgery(TORS)in the treatment of pharyngeal and laryngeal lesions.Methods From 2016 to 2018,the clinical data of 9 cases underwent TORS in Nanjing Drum Tower Hospital were retrospectively analyzed,including 6 cases of oropharyngeal tumors and 3 cases of parapharyngeal space tumors.The operation time,intraoperative blood loss,postoperative fasting time,postoperative hospital stay,postoperative pain and dysphagia scores,postoperative bleeding and nerve injury and other complications were analyzed.Results All 9 patients completed the lesion resection through TORS.The postoperative pathology was benign in 3 cases and malignant in 6 cases,and all resection margins were negative.The operation time was 55-140(85.56±28.77)min.The intraoperative blood loss was 10-50(23.33±11.73)mL,no gastric tube was placed after the operation,the time to resume eating and drinking was 1-3(1.78±0.67)d,and the postoperative hospital stay was 4-7(6.00±1.00)d.Except for 1 oropharyngeal tumor patient who had bleeding from the wound on the day after operation,no complications occurred in the rest.The postoperative follow-up was 4-86 months,and there was no local recurrence,distant metastasis or death in the tumor patients.Conclusion Based on the existing case experience,it can be confirmed to a certain extent that the TORS to resection of throat lesions is safe after reasonable selection of indications and surgical methods,and perioperative and postoperative long-term follow-up effective and minimally invasive.