经口机器人手术并发症总结  

Complication of transoral robotic surgery:single institution study

作　　者：肖海涛 张亚冰 原晓燕 张彬[2] Xiao Haitao;Zhang Yabing;Yuan Xiaoyan;Zhang Bin(Department of Surgery,Beijing United Family Hospital,Beijing 100015,China;Department of Head and Neck Surgery,Peking University Cancer Hospital,Beijing Institute for Cancer Research,Key Laboratory of Carcinogenesis and Translational Research(Ministry of Education),Beijing 100142,China)

机构地区：[1]北京和睦家医院普外科,北京100015 [2]北京大学肿瘤医院暨北京市肿瘤防治研究所头颈外科恶性肿瘤发病机制及转化研究教育部重点实验室,北京100142

出　　处：《中华耳鼻咽喉头颈外科杂志》2025年第3期300-304,共5页Chinese Journal of Otorhinolaryngology Head and Neck Surgery

摘　　要：目的总结经口机器人手术(TORS)围手术期并发症,探讨其危险因素及处理方法。方法回顾性分析2017年9月至2024年6月在北京和睦家医院进行TORS治疗的134例头颈肿瘤患者资料,其中男109例,女25例,年龄24~87岁。包括良性肿瘤9例,恶性肿瘤125例,其中鳞癌119例,腺癌3例,淋巴瘤2例,肉瘤1例。单纯TORS病例37例,TORS同期行颈淋巴清扫96例。对手术后90 d以内的并发症进行总结,采用Clavien-Dindo系统对术后并发症进行分级评价,使用卡方检验进行比较分析。结果共发生手术并发症25例,其中Clavien-Dindo≥Ⅲ级并发症9例。术后并发症包括死亡2例次、大出血3例次、咽瘘3例次、吸入性肺炎2例次、少量出血2例次、牙损伤1例次、环杓关节脱位1例次、舌挫裂伤2例次、长期(>3个月)带管10例次。术后咽瘘与颈清扫的范围显著相关(χ^(2)=9.86,P<0.05),Clavien-Dindo≥Ⅲ级并发症与颈清扫的范围(χ^(2)=13.91,P<0.05)、肿瘤N分期(χ^(2)=14.33,P<0.05)显著相关。结论对N分期高头颈癌患者及颈清扫范围超过3个以上的区域的TORS,需要格外警惕手术并发症的发生。ObjectiveTo investigate the complications of transoral robotic surgery(TORS)and to identify the risk factors for the complications.MethodsThis was a retrospective study of 134 cases of head and neck tumors underwent TORS at the Department of Surgery of Beijing United Family Hospital from September 2017 to June 2024.There were 9 cases of benign tumors and 125 cases of malignant tumors,including 119 squamous cell carcinomas,3 adenocarcinomas,2 lymphomas,and 1 sarcoma.There were 37 cases of pure TORS and 96 cases of TORS combined with neck dissection.Postoperative complications within 90 days were collected and graded with the Clavien-Dindo system.χ^(2)test was used for statistical analysis.ResultsA total of 25(18.7%)cases experienced surgical complications,including 9 cases with Clavien-Dindo grade≥Ⅲcomplications.Postoperative complications included 2 cases of death,3 cases of massive hemorrhage,3 cases of pharyngeal fistula,2 cases of aspiration pneumonia,2 cases of minor bleeding,1 case of tooth injury,1 case of arytenoid dislocation,2 cases of tongue laceration,and 10 cases of long-term(>3 months)tracheostomy open.Postoperative pharyngeal fistula was significantly correlated with the scope of neck dissection(χ^(2)=9.86,P<0.05),and Clavien-Dindo grade≥Ⅲcomplications were significantly correlated with the scope of neck dissection(χ^(2)=13.91,P<0.05)and tumor N stage(χ^(2)=14.33,P<0.05).ConclusionThe high N-stage and neck dissection involving more than three regions are risk factors for the complications of TORS for head and neck tumors.

关 键 词：头颈部肿瘤 经口机器人手术 并发症 

分 类 号：R739.91[医药卫生—肿瘤]