等离子射频技术辅助经口微创手术治疗口咽及口腔恶性肿瘤的临床观察  

Clinical observation of coblation assisted transoral microsurgery for the treatment of oral and oropharygneal malignancy

作　　者：肖水芳[1] 赵欣[1] 张俊波[1] 沈泓[1] 赵恩民[1] 

机构地区：[1]北京大学第一医院耳鼻咽喉头颈外科,北京100034

出　　处：《临床耳鼻咽喉头颈外科杂志》2017年第22期1705-1710,共6页Journal of Clinical Otorhinolaryngology Head And Neck Surgery

摘　　要：目的:探讨等离子射频(RFC)技术辅助的经口微创手术在口咽及口腔恶性肿瘤治疗中的可行性和有效性。方法:回顾性分析2008-08-2017-08期间就诊并顺利完成RFC技术辅助经口手术治疗的19例口咽及口腔恶性肿瘤患者的资料,其中包括经病理证实的4例口腔鳞状细胞癌(SCC)(2例舌癌及2例口底癌),11例口咽SCC(5例扁桃体癌,4例软腭癌,1例舌根癌及1例软腭下咽重复癌),4例口咽淋巴造血系统恶性肿瘤(3例扁桃体肿瘤,1例累及扁桃体和舌根)。根据AJCC指南,4例口腔癌的分期分别为T_1N_0M_01例、T_1N_2M_01例、T_2N_1M_01例及T_2N_2M_01例;11例口咽癌的临床分期分为T_1N_0M_05例、T_2N_0M_04例、T_2N_1M_01例及T_2N_2M_01例。结果:19例患者中接受同期淋巴结清扫及气管切开术的患者分别为6例及4例,单独RFC经口手术的术中出血量均控制在20ml以内,手术时间均控制在2h以内,术后13例患者当天即可恢复经口进食流食,4例气管切开的患者均可顺利拔管;4例淋巴造血系统肿瘤患者术后转诊至血液科进一步诊治,余15例SCC患者中除1例术后出院即失访外,其他14例随访时间6~108个月(中位时间24.5个月),至随访结束未发现局部复发病例及肿瘤相关性死亡病例,仅1例软腭下咽重复癌患者术后5个月对侧下咽及食管再发新生癌伴颈部淋巴结转移,另有1例软腭癌患者术后18个月发现颈部淋巴结转移;另有2例患者分别于术后5个月及12个月时因脑出血及心脏病死亡,Kaplan-Meier曲线计算的3年无瘤生存率及总体生存率分别为75.0%及77.9%;所有患者均未发生与手术相关的吞咽、发声及呼吸功能障碍。结论:RFC技术辅助经口手术治疗口腔及口咽恶性肿瘤疗效明确,多数病例能避免开放入路手术及气管切开术的实施,其优点主要体现在术中出血控制、手术难度降低及手术时间缩短和较快的恢复速度、较低的并发症发生率及较高的功能保留率。Objective：To evaluate the feasibility and effectiveness of coblation assisted transoral surgery for the treatment of oral and oropharyngeal malignancy.Method：19 patients who suffered from oral or oropharyngeal malignant tumors underwent coblation assisted transoral surgery from August 2008 to August 2017 were studied.According to the tumor sites and pathological results,there were four oral squamous cell carcinoma（SCC）（two tongue carcinoma and two mouth floor carcinoma）,eleven oropharygneal SCC（five tonsillar carcinoma,four soft palate carcinoma,one tongue base cartinama and one multiple carcinoma invading both soft palatine and hypopharynx）,and four lymphatic and hematopoietic malignancies（three tonsillar tumors and one tumor invading both tonsil and tongue base）.According to AJCC guideline,the stages of four oral SCC were T_1N_0M_0,T_1N_2M_0,T_2N_1M_0,and T_2N_2M_0 respectively;while the stages of eleven orophygneal SCC were T_1N_0M_0 for 5 patients,T_2N_0M_0 for 4 patients,T_2N_1M_0 for one patient,and T_2N_2M_0 for one patient respectively.Result：Among the 19 patients studied,concurrent neck dissections and tracheotomies were performed in six and four patients respectively.For all the transoral procedures,the blood loss could be controlled within 20 ml,while the operative time were controlled within two hours.13 patients started oral feeding the day they were operated on.All of the four patients who underwent the tracheotomy could be decannulated successfully after surgery.Four patients diagnosed as lymphatic and hematopoietic malignancies turned to hematology department for further treatments.For the remaining 15 SCC patients,14 were followed up successfully with one loss to follow-up：the follow up time ranged from6 to 108 months,during these times,one patient with multiple carcinomas invading the soft palate and hypopharynx had developed new carcinomas located in contralateral hypopharynx and esophagus and had the metastasis in cervical lymph nodes 5 months after surgery,another pati

关 键 词：等离子射频 口咽恶性肿瘤 口腔恶性肿瘤 微创手术 

分 类 号：R739.6[医药卫生—肿瘤]