上海口腔医学

上海口腔医学 ›› 2023, Vol. 32 ›› Issue (5): 508-512.doi: 10.19439/j.sjos.2023.05.011

• 论著 • 上一篇    下一篇

经口机器人辅助咽后淋巴结清扫术治疗头颈部恶性肿瘤的疗效及预后因素的Cox模型分析

丁泰然, 居来提·吐尔逊, 姚志涛, 买买提吐逊·吐尔地   

  1. 新疆医科大学第一附属医院（附属口腔医院）口腔颌面创伤正颌外科,新疆维吾尔自治区口腔医学研究所,新疆 乌鲁木齐 830054
  • 收稿日期:2023-04-24 修回日期:2023-05-17 出版日期:2023-10-25 发布日期:2023-11-03
  • 通讯作者: 买买提吐逊·吐尔地,E-mail: maimaitituxun@aliyun.com
  • 作者简介:丁泰然（1990-）,男,硕士,住院医师,E-mail: chadwickding@163.com
  • 基金资助:
    新疆维吾尔自治区自然科学基金（2022D01C251）

Cox model analysis of curative effect and prognostic factors of oral robot-assisted RPLN dissection for head and neck malignancies

DING Tai-ran, Julaiti·Tuerxun, YAO Zhi-tao, Maimaitituxun·Tuerdi   

  1. Department of Oral and Maxillofacial Trauma & Orthognathic Surgery, The First Affiliated Hospital (Affiliated Stomatological Hospital) of Xinjiang Medical University, Institute of Stomatology in Xinjiang Uygur Autonomous Region. Wulumuqi 830054, Xinjiang Uygur Autonomous Region, China
  • Received:2023-04-24 Revised:2023-05-17 Online:2023-10-25 Published:2023-11-03

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摘要： 目的：探讨经口机器人辅助咽后淋巴结（retropharyngeal lymph node,RPLN）清扫术治疗头颈部恶性肿瘤的疗效及预后因素的Cox模型分析。方法：选择2017年1月—2019年12月接受诊治且随访至2022年12月的头颈部恶性肿瘤患者68例,均予以经口机器人辅助RPLN清扫术治疗,对比临床缓解率、临床控制率、手术时间、术中出血量、住院时间及随访第1、2、3年的生存率、生存时间。采用SPSS 22.0软件包对数据进行统计学分析。结果：68例头颈部恶性肿瘤患者均顺利完成经口机器人辅助RPLN清扫术治疗,所有患者术后均未出现咽后切口大出血、霍纳综合征及吸入性肺炎等并发症。随访3年,生存时间（31.15±4.93）个月,随访第1年生存率为91.18%（62/68）、第2年生存率为85.29%（58/68）、第3年生存率为70.59%（48/68）。不同性别、年龄、疾病类型、原发病灶、淋巴结包膜外侵犯及周围神经受侵犯的患者,3年生存率相比差异无统计学意义（P>0.05）。不同T分期、N分期、TNM分期、受侵淋巴结最大直径和脉管癌栓的患者3年生存率相比,差异有统计学意义（P<0.05）。Cox比例风险回归模型分析结果显示,T3~4期、N2b~3期、TNM分期为Ⅳb期、受侵淋巴结最大直径>6 cm和脉管癌栓是影响头颈部恶性肿瘤患者术后3年生存率的独立危险因素（P<0.05）。结论：经口机器人辅助RPLN清扫术治疗头颈部恶性肿瘤具有一定疗效,但T分期、N分期、TNM分期、受侵淋巴结最大直径和脉管癌栓等因素会影响患者生存率,临床上应提高重视程度。

关键词: 经口机器人, 咽后淋巴结清扫术, 头颈部恶性肿瘤, Cox模型

Abstract: PURPOSE: To investigate the efficacy and prognostic factors of oral robot-assisted retropharyngeal lymph node (RPLN) dissection in the treatment of head and neck malignancies. METHODS: Sixty-eight patients with head and neck malignant tumors who were treated in our hospital from January 2017 to December 2019 and followed up until December 2022 were treated by oral robot-assisted RPLN dissection. The clinical remission rate, clinical control rate, operation time, intraoperative blood loss, length of hospital stay, and the survival rate and survival time at 1, 2 and 3 years of follow-up were compared. SPSS 22.0 software package was used for statistical analysis of the data. RESULTS: All 68 patients with head and neck tumors were successfully treated by oral robot-assisted RPLN resection, and no complications such as postpharyngeal incision massive bleeding, Horner syndrome, aspiration pneumonia were found in all patients. The follow-up was 3 years, the survival time was(31.15±4.93) months, the survival rate was 91.18%(62/68) at the first year, 85.29%(58/68) at the second year and 70.59% (48/68) at the third year. There was no significant difference in 3-year survival rate among different genders, ages, disease types, primary lesions, exocapsular lymph node invasion and peripheral nerve invasion (P>0.05). There were significant differences in the 3-year survival rate of different T stages, N stages, TNM stages, maximum diameter of invaded lymph nodes and vascular cancer thrombus(P<0.05). Cox proportional risk regression model analysis showed that stage T3 to 4, stage N2b to 3, stage Ⅳb TNM, maximum diameter of invaded lymph node >6 cm and vascular cancer thrombi were independent risk factors affecting the 3-year survival rate of head and neck cancer patients after surgery(P<0.05). CONCLUSIONS: Oral robotic assisted RPLN dissection has certain efficacy in the treatment of head and neck malignant tumors, but the survival rate of patients is affected by T stage, N stage, TNM stage, maximum diameter of invaded lymph nodes, vascular cancer thrombolus and other factors, which should be paid more attention in clinic.

Key words: Transoral robot, Postpharyngeal lymph node dissection, Head and neck malignancies, Cox model

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