Xu K, Cai L J, Chen H, Li Y Y, Wang Z B, Huang H Y, Chu H Q, Cui Y H, Liu Z, Lu X
Department of Otorhinolaryngology Head and Neck Surgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China.
Department of Operation, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China.
Zhonghua Er Bi Yan Hou Tou Jing Wai Ke Za Zhi. 2020 Feb 7;55(2):109-115. doi: 10.3760/cma.j.issn.1673-0860.2020.02.006.
To evaluate the indication, safety and effectiveness of transoral robotic surgery (TORS) for oropharyngeal cancer based on our preliminary experience. 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. 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. With proper indications, the application of TORS in oropharyngeal cancer is a relatively safe, effective and minimal invasive therapy, which merits more clinical applications.
基于我们的初步经验，评估经口机器人手术（TORS）治疗口咽癌的适应症、安全性和有效性。分析了2017年3月至2018年10月在华中科技大学同济医学院附属同济医院使用达芬奇Si手术系统接受TORS治疗的12例患者，其中包括6例扁桃体癌、5例舌根癌和1例下咽后壁癌。并对手术时间、术中出血量、术后局部出血、呼吸困难、神经功能损伤、经口进食时间、是否接受放化疗进行了分析。12例患者的所有肿瘤均通过TORS整块切除。手术时间为25至80分钟，平均34.2分钟。出血量为10至50毫升，平均20.8毫升。经口进食恢复时间为1至30天，平均8.4天。TORS术后无患者行气管切开术。此外，术后无患者出现气道梗阻、出血或神经损伤症状。12例患者均达到病理切缘阴性。患者随访4至22个月，中位随访时间为12个月。所有合并T3期以上或N2期以上的患者均被推荐至肿瘤内科医生处，若没有相关禁忌证，则接受放疗或放化疗。未发现局部复发或远处转移病例。在有适当适应症的情况下，TORS应用于口咽癌是一种相对安全、有效且微创的治疗方法，值得更多临床应用。
