發(fā)布時(shí)間：2018-02-24 12:40

  本文關(guān)鍵詞： 等離子射頻 口咽惡性腫瘤 口腔惡性腫瘤 微創(chuàng)手術(shù)　出處：《臨床耳鼻咽喉頭頸外科雜志》2017年22期 　論文類型：期刊論文

【摘要】：目的:探討等離子射頻(RFC)技術(shù)輔助的經(jīng)口微創(chuàng)手術(shù)在口咽及口腔惡性腫瘤治療中的可行性和有效性。方法:回顧性分析2008-08-2017-08期間就診并順利完成RFC技術(shù)輔助經(jīng)口手術(shù)治療的19例口咽及口腔惡性腫瘤患者的資料,其中包括經(jīng)病理證實(shí)的4例口腔鱗狀細(xì)胞癌(SCC)(2例舌癌及2例口底癌),11例口咽SCC(5例扁桃體癌,4例軟腭癌,1例舌根癌及1例軟腭下咽重復(fù)癌),4例口咽淋巴造血系統(tǒng)惡性腫瘤(3例扁桃體腫瘤,1例累及扁桃體和舌根)。根據(jù)AJCC指南,4例口腔癌的分期分別為T_1N_0M_01例、T_1N_2M_01例、T_2N_1M_01例及T_2N_2M_01例;11例口咽癌的臨床分期分為T_1N_0M_05例、T_2N_0M_04例、T_2N_1M_01例及T_2N_2M_01例。結(jié)果:19例患者中接受同期淋巴結(jié)清掃及氣管切開術(shù)的患者分別為6例及4例,單獨(dú)RFC經(jīng)口手術(shù)的術(shù)中出血量均控制在20ml以內(nèi),手術(shù)時(shí)間均控制在2h以內(nèi),術(shù)后13例患者當(dāng)天即可恢復(fù)經(jīng)口進(jìn)食流食,4例氣管切開的患者均可順利拔管;4例淋巴造血系統(tǒng)腫瘤患者術(shù)后轉(zhuǎn)診至血液科進(jìn)一步診治,余15例SCC患者中除1例術(shù)后出院即失訪外,其他14例隨訪時(shí)間6~108個(gè)月(中位時(shí)間24.5個(gè)月),至隨訪結(jié)束未發(fā)現(xiàn)局部復(fù)發(fā)病例及腫瘤相關(guān)性死亡病例,僅1例軟腭下咽重復(fù)癌患者術(shù)后5個(gè)月對(duì)側(cè)下咽及食管再發(fā)新生癌伴頸部淋巴結(jié)轉(zhuǎn)移,另有1例軟腭癌患者術(shù)后18個(gè)月發(fā)現(xiàn)頸部淋巴結(jié)轉(zhuǎn)移;另有2例患者分別于術(shù)后5個(gè)月及12個(gè)月時(shí)因腦出血及心臟病死亡,Kaplan-Meier曲線計(jì)算的3年無(wú)瘤生存率及總體生存率分別為75.0%及77.9%;所有患者均未發(fā)生與手術(shù)相關(guān)的吞咽、發(fā)聲及呼吸功能障礙。結(jié)論:RFC技術(shù)輔助經(jīng)口手術(shù)治療口腔及口咽惡性腫瘤療效明確,多數(shù)病例能避免開放入路手術(shù)及氣管切開術(shù)的實(shí)施,其優(yōu)點(diǎn)主要體現(xiàn)在術(shù)中出血控制、手術(shù)難度降低及手術(shù)時(shí)間縮短和較快的恢復(fù)速度、較低的并發(fā)癥發(fā)生率及較高的功能保留率。
[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.
【作者單位】： 北京大學(xué)第一醫(yī)院耳鼻咽喉頭頸外科;
【分類號(hào)】：R739.6;R739.8

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