经口机器人手术联合游离皮瓣重建：单中心 241 例患者的功能结局。
Transoral robotic surgery with free flap reconstruction: Functional outcomes of 241 patients at a single institution.
机构信息
Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, Pennsylvania, USA.
Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA.
出版信息
Head Neck. 2024 Jul;46(7):1601-1613. doi: 10.1002/hed.27761. Epub 2024 Apr 10.
BACKGROUND
Transoral robotic surgery (TORS) for oropharyngeal malignancy optimizes oncologic outcomes while preserving functionality. This study identifies patterns of functional recovery after TORS with free flap reconstruction (FFR).
METHODS
Retrospective cohort study at a tertiary care center of patients with primary oropharyngeal tumors treated with TORS with FFR between 2010 and 2022. Patients were categorized into: adjuvant chemoradiation or radiation, or no adjuvant therapy (NAT). Functional outcomes were measured by functional oral intake scale (FOIS).
RESULTS
241 patients were included. FOIS declined at first postoperative appointment (median = 7.0 to 2.0, IQR = [7.0, 7.0], [2.0, 4.0]), and progressively improved to 6.0 (5.0, 6.0) after 1 year, with NAT having the highest FOIS (7.0, p < 0.05). Predictors of poor long-term FOIS included RT and hypoglossal nerve (CN XII) involvement (p < 0.05).
CONCLUSIONS
TORS with FFR leads to good long-term function with minimal intake restrictions. Radiation therapy and CN XII involvement increase risk of worse functional outcomes.
背景
经口机器人手术（TORS）治疗口咽恶性肿瘤可优化肿瘤学结果，同时保留功能。本研究旨在明确游离皮瓣重建（FFR）后 TORS 术后功能恢复的模式。
方法
这是一项在一家三级医疗中心进行的回顾性队列研究，研究对象为 2010 年至 2022 年间接受 TORS 联合 FFR 治疗的原发性口咽肿瘤患者。患者被分为辅助放化疗或单纯放疗，或无辅助治疗（NAT）。采用功能性口腔摄入量表（FOIS）测量功能结局。
结果
共纳入 241 例患者。术后首次就诊时 FOIS 下降（中位数=7.0 至 2.0，IQR=[7.0，7.0]，[2.0，4.0]），1 年后逐渐改善至 6.0（5.0，6.0），NAT 组的 FOIS 最高（7.0，p<0.05）。RT 和舌下神经（CN XII）受累是长期 FOIS 不良的预测因素（p<0.05）。
结论
TORS 联合 FFR 可获得良好的长期功能，且摄入限制最小。放疗和 CN XII 受累增加了功能结局不良的风险。
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