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

发布时间：2018-02-24 12:40

本文关键词： 等离子射频口咽恶性肿瘤口腔恶性肿瘤微创手术　出处：《临床耳鼻咽喉头颈外科杂志》2017年22期 　论文类型：期刊论文

【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。
[Abstract]:Objective: to investigate the feasibility and effectiveness of plasma radiofrequency catheter ablation (RFC-) assisted transoral minimally invasive surgery in the treatment of oropharyngeal and oral malignant tumors. Methods: retrospective analysis was made during 2008-08-2017-08 and RFC technique was successfully completed in the treatment of oropharyngeal and oral malignancies. The data of 19 patients with oropharyngeal and oral malignant tumor treated by surgery, These include 4 cases of squamous cell carcinoma of oral cavity confirmed by pathology, 2 cases of tongue carcinoma and 2 cases of carcinoma of the floor of mouth, 11 cases of oropharynx carcinoma and 4 cases of soft palate carcinoma, 1 case of tongue root carcinoma and 1 case of soft palate hypopharynx duplicate carcinoma, 4 cases of malignant hematopoietic system of oropharynx. According to the AJCC guidelines, the clinical stages of 4 cases of oral cancer were: T1N0M0M01 and T 2N1M1M01; T2N1N2M01; T2N1N2M01; T2N2N2M01; T2N0M01; T2N2M2M01; T2N2M2M01; T2N2N2M2M01; T2N1M1M01; T2N2M2M01; T2N2M2M01; T2N1M1M01; T2N2M2M01; and T2N2M2M01. Of the 19 patients, 6 underwent lymphadenectomy and 4 underwent tracheotomy, The intraoperative bleeding of RFC alone was controlled within 20ml, and the operative time was controlled within 2 hours. On the same day, 13 patients could resume oral feeding, 4 patients with tracheotomy, 4 patients with lymphatic hematopoietic tumors could be transferred to hematology department for further diagnosis and treatment. In the remaining 15 patients with SCC, except for one patient who was discharged from hospital immediately after operation, 14 patients were followed up for 6 ~ 108 months (median time 24.5 months). No cases of local recurrence or tumor-related death were found at the end of follow-up. Cervical lymph node metastasis was found in 1 patient with repeated carcinoma of soft palate hypopharynx and esophagus with cervical lymph node metastasis at 5 months postoperatively and in 1 patient with soft palate carcinoma 18 months after operation. The 3-year tumor-free survival rate and overall survival rate calculated by Kaplan-Meier curve were 75.0% and 77.9 respectively in 2 patients who died of intracerebral hemorrhage and heart disease at 5 and 12 months postoperatively. Conclusion the effect of oral surgery on oral and oropharyngeal malignant tumors is clear, and most of the patients can avoid the implementation of open approach and tracheotomy, the advantages of which are mainly reflected in the intraoperative bleeding control. The difficulty of operation was reduced, the operation time was shortened, the recovery rate was faster, the complication rate was lower and the function retention rate was higher.
【作者单位】：北京大学第一医院耳鼻咽喉头颈外科;
【分类号】：R739.6;R739.8

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