Objective: To investigate the indication, feasibility, and safety of da Vinci robotic surgical system in pharyngolaryngeal tumor resection. Methods: Thirty patients were diagnosed with pharyngolaryngeal tumors and treated with a transoral robotic surgery (TORS) in Beijing Anzhen Hospital from June 1, 2016 through November 30, 2017. Inclusion criteria included lesions of the oropharynx (n=13), parapharyngeal space (n=7), larynx (n=6) and hypopharynx (n=4). Twenty cases were males and ten cases were females. The median age was 56 years old (ranging from 30 to 81 years). Results: The robotic surgeries were performed successfully on 30 patients. One patient (3.3%) underwent TORS combined with a neck incision. The mean operative time was 40.7 min. The mean blood loss was 15.8 ml. The mean recovery time for oral intake was 5.3 days. The mean hospital stay was 9 days. None of the patients underwent tracheotomy or mandible split. Postoperative pathological examination showed that 18 cases (60.0%) were malignant and 1 case (5.6%) had positive surgical margin. Sixteen cases received neck dissection. No serious complications occurred during or after the operation. There was no local recurrence, metastasis or death except for regional recurrences in 2 cases (11.1%) with a follow-up of 1 to 18 months(median 13 months). Conclusion: Transoral robotic surgery is a feasible, safe and effective surgical procedure with clear operation field, rapid surgical access, minimally invasive surgery, lesser hemorrhage, good cosmetic effect and fast recovery.
目的： 探讨达芬奇机器人经口入路切除咽喉肿瘤的适应证、可行性及安全性。 方法： 回顾性分析首都医科大学附属北京安贞医院耳鼻咽喉头颈外科2016年6月1日至2017年11月30日共30例达芬奇机器人经口入路切除咽喉部肿瘤的临床资料，其中口咽肿瘤13例，咽旁间隙肿瘤7例，喉肿瘤6例，下咽肿瘤4例。男性20例，女性10例；年龄30～81岁，中位年龄56岁。 结果： 30例患者均在达芬奇机器人辅助下经口入路完全切除，1例患者(3.3%)术中发现肿瘤为来源于腮腺深叶的多形性腺瘤，追加颈腮腺切口。平均机器人手术时间40.7 min，平均出血15.8 ml，平均经口进食时间5.3 d，平均住院时间9 d。所有患者均未行气管切开或下颌骨裂开。术后病理提示恶性病变共18例(60.0%)，切缘阳性1例(5.6%)，同期行颈淋巴清扫16例(53.3%)。除1例(3.3%)患者出现一过性霍纳综合征外，其余均无出血、声嘶、呛咳、伸舌偏斜、呼吸困难、面神经麻痹等并发症。术后随访1～18个月，中位随访时间13个月。2例(11.1%)颈部淋巴转移，无局部复发、远处转移或死亡病例。 结论： 达芬奇机器人经口咽喉肿瘤切除具有术野清晰、手术路径短、出血少、创伤小、咽喉功能保留及美容效果好、术后恢复快等优点，是安全、有效、可行的方法。.
Keywords: Otorhinolaryngologic neoplasms; Surgical procedures, minimally invasive; Transoral robotic surgery.