经口机器人手术切除头颈癌咽后转移淋巴结的初步尝试  

Retropharyngeal lymph node metastases from head and neck cancer removed by transoral robotic surgery

作　　者：宋明[1] 韩萍[2] 陈树伟[1] 梁发雅[2] 杨安奎[1] 张诠[1] 林沛亮 黄晓明[2] Song Ming;Han Ping;Chen Shuwei;Liang Faya;Yang Ankui;Zhang Quan;Lin Peiliang;Huang Xiaoming(Department of Head and Neck Surgery,Sun Yat-sen University Cancer Center,State Key Laboratory of Oncology in South China,Guangdong Provincial Clinical Research Center for Cancer,Guangzhou 510060,China;Department of Otorhinolaryngology,Sun Yat-sen Memorial Hospital,Sun Yat-sen University,Key Laboratory of Epigenetics and Gene Regulation of Malignant Tumor in Guangdong Province,Guangzhou 510280,China)

机构地区：[1]中山大学肿瘤防治中心头颈科、华南恶性肿瘤防治全国重点实验室、广东省恶性肿瘤临床医学研究中心,广州510060 [2]中山大学孙逸仙纪念医院耳鼻咽喉科、广东省恶性肿瘤表观遗传与基因调控重点实验室,广州510280

出　　处：《中华耳鼻咽喉头颈外科杂志》2025年第3期292-299,共8页Chinese Journal of Otorhinolaryngology Head and Neck Surgery

基　　金：广州市地区临床高新、重大和特色技术项目(重大项目)(2023P-ZD13)。

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)清扫术的安全性及可行性。方法回顾性分析2017年12月至2024年3月中山大学孙逸仙纪念医院和中山大学肿瘤防治中心接受经口机器人辅助RPLN清扫术的35例头颈癌患者的临床数据,男性22例,女性13例,年龄(47.4±13.4)岁。包括鼻咽癌20例,甲状腺癌9例,涎腺癌2例,扁桃体癌2例和下咽癌2例。分析手术时间、术中出血量、术中并发症、术后鼻饲管留置时间、术后住院时间及术后并发症等指标。统计分析使用SPSS 22.0软件。结果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。全程手术时间为130(102,210)min[M(Q 1,Q 3),下同],清扫出RPLN 2(1,3)枚,术中出血量为50(20,100)ml,术中未出现重大出血或器官损伤,术中行预防性气管切开术8例。22例患者术后留置鼻胃管,留置时间为10.5(7.5,14.0)d。术后住院时间为5(4,9)d。术后并发症包括切口裂开4例和吞咽困难4例。术后中位随访时间为23.4个月,5例患者出现进展或复发,其中3例出现区域复发,1例患者发生肺转移,1例患者发生骨转移。患者的2年无区域复发生存率和无病生存率为91.43%和85.71%。结论经口机器人辅助RPLN清扫术是一种安全可行的手术方法,其创伤小、并发症少、安全性较高,应用初期,需谨慎选择适应证。ObjectiveTo evaluate the safety,and feasibility of transoral robot-assisted retropharyngeal lymph node(RPLN)dissection.MethodsClinical data of head and neck cancer patients who underwent transoral robot-assisted RPLN dissection at the Department of Otorhinolaryngology,Sun Yat-sen Memorial Hospital,Sun Yat-sen University,and Sun Yat-sen University Cancer Centre from December 2017 to March 2024 were retrospectively analyzed.A total of 35 patients(22 males,13 females,aged 47.4±13.4 years old)with RPLN metastases from head and neck cancer,including 20 cases of nasopharyngeal cancer,9 cases of thyroid cancer,2 cases of salivary adenocarcinoma,2 cases of tonsil cancer,and 2 cases of hypopharyngeal cancer.Operation time,intraoperative bleeding and complications,postoperative nasogastric tube retention time,hospital stay and complications were evaluated.Statistical analysis was performed using SPSS 22.0 software.ResultsAll patients successfully received transoral robot-assisted RPLN dissection without intermediate open surgery,with removals of 2(1,3)RPLNs.The total operation time was 130(102,210)minutes.The intraoperative bleeding was 50(20,100)ml,and there was no major bleeding or organ damage during the operation.Prophylactic tracheotomy was performed in 8 cases,and postoperatively nasogastric tubes were left in 22 patients,with retention time of 10.5(7.5,14.0)days.Postoperative hospital stay was 5(4,9)days.Postoperative complications included incision dehiscence in 4 cases and dysphagia in 4 cases.The median postoperative follow-up was 23.4 months,with progression or recurrence in 5 patients,including regional recurrence in 3 patients,lung metastasis in 1 patient,and bone metastasis in 1 patient.The 2-year regional failure-free survival and disease-free survival rates were 91.43%and 85.71%,respectively.ConclusionTransoral robot-assisted RPLN dissection is a safe and feasible surgical method with less trauma,fewer complications,and higher safety.Patients need to be carefully selected at the initial stage of applicatio

关 键 词：头颈部肿瘤 咽后淋巴结 淋巴结清扫术 经口机器人手术 

分 类 号：R739.91[医药卫生—肿瘤]