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经口机器人辅助咽后淋巴结清扫术在头颈部恶性肿瘤中的应用

Retropharyngeal lymph node dissection in head and neck cancers treated with transoral robotic surgery

摘要:

目的:评估头颈部恶性肿瘤患者接受经口机器人辅助咽后淋巴结(RPLN)清扫术的适应证、安全性、可行性及手术技巧。方法:回顾性分析2019年5月至2020年7月在中山大学肿瘤防治中心接受经口机器人辅助RPLN清扫术的12例头颈部恶性肿瘤患者的手术方式、手术时间、术中出血量、术中并发症、术后气管套管及鼻胃管留置时间、术后并发症、术后住院时间等,其中鼻咽癌7例,甲状腺癌4例,口咽癌1例。结果:12例患者均顺利完成经口机器人辅助RPLN清扫术,无中转开放手术。10例RPLN完整切除,2例部分切除(均为鼻咽癌患者),平均清扫RPLN 1.7枚。手术时间为(191.3±101.1)min,术中出血量为(150.0±86.6)ml,术中未出现大出血、口腔和口咽等正常器官损伤等情况。8例患者行气管切开术,气管套管留置时间为(11.6±10.7)d。所有患者术后均留置鼻胃管,留置时间为(17.1±10.6)d。术后住院时间为(8.5±5.7)d。术后并发症包括咽后切口裂开2例,吞咽困难2例。术后平均随访6.5个月,患者均未出现疾病进展,10例患者无病生存,2例患者带瘤生存。结论:经口机器人辅助RPLN清扫术安全、可行,与传统开放手术入路相比,创伤小,并发症少,安全性高,具有良好的临床应用前景。经口机器人辅助RPLN清扫术的适应证包括RPLN转移的甲状腺癌、口咽癌、部分鼻咽癌等头颈部恶性肿瘤。RPLN包膜不完整、边界不清、与周围大血管粘连的鼻咽癌患者,应慎重选择经口机器人辅助RPLN清扫术。

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abstracts:

Objective:To evaluate the indications, safety, feasibility, and surgical technique for patients with head and neck cancers undergoing transoral robotic retropharyngeal lymph node (RPLN) dissection.Methods:The current study enrolled 12 consecutive head and neck cancer patients (seven males and four females) who underwent transoral robotic RPLN dissection with the da Vinci surgical robotic system at the Sun Yat-sen University Cancer Center from May 2019 to July 2020. Seven patients were diagnosed as nasopharyngeal carcinoma with RPLN metastasis after initial treatments, 4 patients were diagnosed as thyroid carcinoma with RPLN metastasis after initial treatments, and one patient was diagnosed as oropharyngeal carcinoma with RPLN metastasis before initial treatments. The operation procedure and duration time, intraoperative blood loss volume and complications, nasogastric feeding tube dependence, tracheostomy dependence, postoperative complications, and hospitalization time were recorded and analyzed.Results:All patients were successfully treated by transoral robotic dissection of the metastatic RPLNs, none of which was converted to open surgery. RPLNs were completely resected in 10 patients, and partly resected in 2 patients (both were nasopharyngeal carcinoma patients). The mean number of RPLN dissected was 1.7. The operation duration time and intraoperative blood loss volume were (191.3±101.1) min and (150.0±86.6) ml, respectively. There was no severe intraoperative complication such as massive haemorrhage or adjacent organ injury during surgery. Nasogastric tube use was required in all patients with (17.1±10.6) days of dependence, while tracheotomy was performed in 8 patients with (11.6±10.7) days of dependence. The postoperative hospitalization stay was (8.5±5.7) days. Postoperative complications occurred in 4 patients, including 2 of retropharyngeal incision and 2 of dysphagia. During a follow-up of (6.5±5.1) months, disease-free progression was observed in all patients, 10 patients were disease-free survival and other 2 patients were survival with tumor burden.Conclusions:The transoral robotic RPLN dissection is safety and feasible. Compared with the traditional open surgical approach, it is less traumatic and safer, has fewer complications and good clinical application potentiality. The indications for transoral robotic RPLN dissection include thyroid carcinoma, oropharyngeal carcinoma, and some selected nasopharyngeal carcinoma and other head and neck cancers. Metastatic RPLNs from some nasopharyngeal carcinoma with incomplete capsule, unclear border and adhesion to the surrounding vessels are not suitable for transoral robotic RPLN dissection.

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作者: 陈树伟 [1] 张星 [1] 黎建军 [2] 李卉 [3] 杨安奎 [1] 张诠 [1] 李秋梨 [1] 陈文宽 [1] 贺龙君 [2] 杨中元 [1] 宋明 [1]
作者单位: 华南肿瘤学国家重点实验室 肿瘤医学协同创新中心 中山大学肿瘤防治中心头颈科,广州 510060 [1] 华南肿瘤学国家重点实验室 肿瘤医学协同创新中心 中山大学肿瘤防治中心内镜科,广州 510060 [2] 华南肿瘤学国家重点实验室 肿瘤医学协同创新中心 中山大学肿瘤防治中心影像科,广州 510060 [3]
期刊: 《中华肿瘤杂志》2022年44卷5期 446-449页 MEDLINEISTICPKUCSCD
栏目名称: 临床应用
DOI: 10.3760/cma.j.cn112152-20200907-00803
发布时间: 2022-07-31
基金项目:
国家自然科学基金青年项目 National Natural Science Foundation of China
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