达芬奇Xi手术机器人在经口咽喉肿瘤手术中的可行性及围手术期安全性探讨  

Feasibility and perioperative safety of transoral robotic surgery with da Vinci Xi platform

作　　者：徐成志 吴春萍[1] 薛继尧 周梁[1] 陶磊[1] Xu Chengzhi;Wu Chunping;Chi-Yao Hsueh;Zhou Liang;Tao Lei(Department of Head and Neck Surgery,Eye Ear Nose and Throat Hospital,Fudan University,Shanghai 200031,China)

机构地区：[1]复旦大学附属眼耳鼻喉科医院头颈外科,上海200031

出　　处：《中华耳鼻咽喉头颈外科杂志》2022年第5期565-571,共7页Chinese Journal of Otorhinolaryngology Head and Neck Surgery

基　　金：国家自然科学基金(81772878,81972529);上海市科学技术委员会项目(18441903400,19411961300)。

摘　　要：目的探讨达芬奇Xi手术机器人系统在经口咽喉肿瘤手术中的可行性及围手术期处理方式。方法回顾性分析复旦大学附属眼耳鼻喉科医院头颈外科2020年7月27日至2021年10月31日,应用达芬奇Xi手术机器人经口切除咽喉肿瘤的55例连续性病例资料,男性44例,女性11例,年龄25~79岁。其中口咽肿瘤41例,咽旁间隙肿瘤9例,喉肿瘤2例,下咽肿瘤2例,咽后间隙肿瘤1例。分析患者的手术时间、术中出血量、术后住院天数、围手术期气管切开情况、鼻饲饮食及出血等并发症情况。结果55例患者中54例应用达芬奇机器人经口入路切除,1例梨状窝癌因下切缘暴露不佳术中改为开放手术。机器人平均手术时间为64.4 min,平均出血量为24.8 ml,平均术后住院天数为6.9 d,平均经口进食时间为11.1 d,17例(30.9%)患者术中行预防性气管切开。38例咽喉癌患者中,同期行颈部淋巴清扫28例。所有患者术中术后无严重并发症出现。随访时间1~15个月,1例患者术后10个月复发,其余患者无复发及转移。结论在适应证选择合理的前提下,应用达芬奇Xi机器人手术经口切除咽喉肿瘤具有安全、有效、微创的优点。Objective To explore the feasibility and perioperative safety of transoral robotic surgery with da Vinci Xi platform for pharyngolaryngeal tumors.Methods A retrospective analysis was performed on 55 consecutive cases with resection of pharyngolaryngeal tumors by transoral robotic surgery with da Vinci Xi platform from July 27,2020 to October 31,2021 in the Department of Head and Neck Surgery,Fudan University Eye,Ear,Nose and Throat Hospital,including 44 males and 11 females,aged 25-79 years.There were 41 cases of oropharyngeal tumors,9 cases of parapharyngeal space tumors,2 cases of laryngeal tumors,2 cases of hypopharyngeal tumors and 1 case of retropharyngeal space tumor.Operative time,intraoperative blood loss,postoperative hospital stay,perioperative tracheotomy,nasal feeding,hemorrhage and other complications were analyzed.Results Of the 55 patients,54 received resection of pharyngolaryngeal tumors by da Vinci robot through oral approach,and only 1 case of pyriform sinus carcinoma underwent a conversion to open surgery due to poor exposure of lower margin.The average surgical time for the patients with transoral robotic surgeries was 64.4 min,the average blood loss was 24.8 ml,the average postoperative hospital stay was 6.9 d,and the average oral feeding time was 11.1 d.Seventeen patients(30.9%)underwent preventive tracheotomy during surgery.Among 38 cases of laryngeal cancer,28 underwent simultaneously neck dissection.No serious complications occurred in all patients during and after operation.The follow-up time was 1-15 months.Aside from 1 patient had a relapse 10 months after surgery,other patients had no recurrence or metastasis.Conclusion Transoral robotic surgery with da Vinci Xi is safe,effective and minimally invasive for resection of pharyngolaryngeal tumors under reasonable indications.

关 键 词：经口机器人手术 达芬奇机器人 咽喉肿瘤 适应证 围手术期 

分 类 号：R739.6[医药卫生—肿瘤]