经下颌下下颌骨角部前方截骨入路颞下窝颅底肿瘤的外科治疗

目的:探讨颞下窝颅底肿瘤的手术入路和手术方法。方法:对9例位于颞下窝颅底的肿瘤采用下颌下切口、下颌骨角部前方截骨入路进行手术治疗,观察手术效果,评价手术方法。结果:9例手术术野暴露充分,手术操作顺利,术后愈合良好,无严重并发症,其中良性肿瘤6例,恶性肿瘤3例,随访12～36个月肿瘤无复发。结论:下颌下、下颌骨角部前方截骨入路进行颞下窝颅底部肿瘤切除治疗效果满意。     

21例患糖尿病口腔外科患者的处理

目的总结患糖尿病口腔外科患者的处理经验。方法2001年3月—2006年3月收治21例患糖尿病口腔外科患者,其中男16例,女5例,年龄40~75岁,平均56岁。腮腺肿瘤10例;颌骨囊肿8例;下颌牙龈癌1例;口底癌2例。多为非依赖型糖尿病,入院前诊断13例,入院后诊断8例。结果20例手术患者术后伤口全部Ⅰ期愈合,1例行放射治疗。都康复出院。随访1个月~2年未发现其他并发症。结论控制糖尿病患者血糖在7.0~8.0mmol/L水平是做好口腔颌面外科患者处理的关键。     

2018例口腔颌面外科日间手术临床分析

目的:总结中南大学湘雅医院口腔颌面外科开展日间手术的临床经验,探讨日间手术在口腔颌面外科的应用效果与安全性。方法:回顾分析2014年7月—2019年6月在中南大学湘雅医院日间手术中心进行治疗的所有口腔颌面外科患者的临床资料,包括患者年龄、性别、疾病名称、麻醉与手术方式或取消原因、住院时间、延期出院原因、术后并发症发生情况及医疗费用等。选取其中手术量最多的8种疾病,以普通住院病房为对照,比较同类型疾病平均住院时间与医疗费用的差异。采用SPSS 23.0软件包对数据进行统计学分析。结果:在纳入研究期间的5年内,中南大学湘雅医院共完成口腔颌面外科日间手术2018例,疾病类型以口腔颌面部软组织肿物、牙及颌骨病变、唾液腺疾病为主。患者年龄2~77岁,平均34.45岁,男女比例为6:4。手术取消率1.13%,术后并发症发生率0.64%,平均住院时间0.89 d,延迟出院率0.40%。与普通病房相比,同类型疾病住院时间与医疗费用均显著降低(P<0.05)。结论:口腔颌面外科能够实施日间手术的疾病类型多,患者依从性好,住院时间短,医疗资源利用率高。在规范管理的前提下,安全可行,值得进一步推广应用。     

咽旁颞下区肿瘤的诊断和手术治疗体会

目的:探讨位于颞下窝、咽旁间隙肿瘤的临床表现及诊断方法 ,分析颈侧入路及耳屏前入路的手术疗效,总结治疗心得体会。方法:回顾分析2010—2014年间,15例颞下窝、咽旁间隙肿瘤患者临床资料,包括影像学、组织学检查,分别采用单纯颈侧入路、颈侧入路+下颌骨劈开外旋术或耳屏前切口入路方式切除肿瘤。结果:15例患者均完整切除肿瘤,术后随访1~5年,13例良性肿瘤均无复发,2例恶性肿瘤患者无瘤生存3~5年。结论:术前行增强CT和MRI可明确颞下窝、咽旁肿瘤占位及大小,对手术方案的制定有一定帮助,但不应完全依照影像学检查结果实施手术。利用颈侧软组织可让性,能有效切除咽旁间隙体积较小的肿瘤。对于位置较高且粘连较重的良性肿瘤及侵袭性较强的恶性肿瘤,可考虑采用"颈侧入路+下颌骨劈开外旋术"或"耳屏前切口入路+颧弓切断术"切除。     

侧颅底相关头颈肿瘤的手术治疗

目的:探讨颞下窝及翼腭窝区侧颅底受累头颈肿瘤的手术进路及疗效。方法:2005年4月～2009年6月,15例颞下窝及翼腭窝区肿物并同时伴有侧颅底受累的患者在中山大学孙逸仙纪念医院口腔颌面外科进行手术治疗。采用颅面联合入路10例、颞下窝入路3例,Weber-Ferguson加Lynch入路2例。结果:15例患者肿瘤全部切除,11例同期行颅底软硬组织缺损的修复。无手术死亡,无术后偏瘫或脑脊液漏。结论:颞下窝及翼腭窝区颅底受侵肿物的手术入路应视肿瘤部位及颅脑组织受影响的程度而定。肿瘤切除同时行缺损修复可降低手术风险及并发症的发生。     

改良下唇切口进路切除口腔恶性肿瘤

目的 :设计一种改良下唇切口的手术径路,便于口腔内深部肿瘤的暴露和切除,改善术后面部的外形与功能。方法:15例口腔恶性肿瘤患者,采用改良下唇切口的手术径路:经口角附近沿颏面沟自然弧度向下与颈淋巴清扫颌下切口连接,切口线隐蔽于颏面沟皮肤皱折区。结果:经口角旁下唇切口较下唇正中切口短,对组织结构损伤相对减小,病灶暴露更加充分,操作更加便捷。经术后1年以上随访,疤痕隐蔽、唇红缘无凹陷、颏部外形圆润,无口角歪斜等面瘫症状。结论:采用改良下唇切口进路切除口腔恶性肿瘤能充分暴露并完整切除肿瘤,且术后有较满意的外形及功能,可作为口腔内深在肿瘤切除的常规手术径路。     

CO2激光治疗口腔黏膜浅表病变73例临床分析

目的:评价二氧化碳（CO₂）激光治疗仪在口腔黏膜浅表病变中的应用安全性和优越性。方法:回顾分析2012年6月—2013年12月应用CO₂激光治疗口腔黏膜浅表病变的73例患者,其中包括脉管畸形25例、口腔黏膜白斑22例、口腔黏膜扁平苔藓18例、口腔黏膜及唇红黏膜疣状痣8例。病变范围0.8 cm×0.8 cm⁴.0 cm×3.0 cm;同时选取常规手术刀配合电刀切除的口腔黏膜浅表病变20例进行比较。记录所有患者的手术时间和出血量,比较2组患者的手术时间和出血量。采用SPSS19.0软件包对数据进行t检验。结果:73例患者术程顺利,手术时间3¹0 min,平均5.5 min,手术平均出血量5 mL;术后无感染,创口均一期愈合;随访1 a,2例口腔黏膜白斑患者术后复发,再次行手术治疗效果良好。对照组手术时间4¹5 min,平均9.5 min,手术平均出血量10 mL;20例对照组患者术后无感染,创口一期愈合。结论:应用CO₂激光治疗口腔黏膜浅表病变具有出血少、手术视野清晰、复发率低和手术时间短等优点,值得临床推广应用。     

传统颈淋巴清扫术经典手术入路的反思

目的 :对传统颈淋巴清扫术手术入路进行分析 ,以选择最佳手术切口。方法 :收集颈淋巴清扫术 3 6例 ,其中矩形切口 18例 ,T形切口 15例 ,平行切口 3例。观察三种手术入路术后皮肤坏死情况 ,将皮瓣坏死分 3度比较分析。并观察三种手术入路视野暴露情况、操作难易程度及操作时间。结果 :矩形切口出现皮肤坏死率与T形切口、平行切口皮肤坏死率有显著性的差异 (P <0 .0 0 1)。矩形切口和T形切口均能很好地暴露术野 ;平行切口视野暴露较差 ,操作难度大 ,手术时间长。结论 :颈淋巴清扫术中矩形切口手术入路不是一种十分理想的手术入路 ,为了避免皮肤坏死并发症的产生 ,应当改良此切口入路或选用T形切口和其他切口入路。     

经口腔机器人手术治疗头颈癌的初步经验

该文旨在研究经口腔机器人手术（TORS）治疗头颈部恶性肿瘤的技术可行性、安全性及有效性。对应用daVinci外科机器人治疗的20例患者进行前瞻性研究。纳入标准为成年患者的早期头颈癌，包括口腔癌、口咽癌、下咽癌及喉癌。结果，2例无法充分达到手术部位，手术终止。其他18例术后手术切缘阴性。8例行组织重建。10行单侧颈淋巴清扫，5例行双侧颈清，未行气管切开，术中、术后无并发症。     

国产手术机器人辅助下腮腺肿瘤切除1例

机器人手术被誉为外科学领域的“第三次技术革命”,是现代外科学发展的重要里程碑。然而我国创新型手术机器人产业尚处于起步阶段,仅用于部分外科领域。为了探讨国产手术机器人在口腔颌面外科应用的有效性,笔者在国产自主手术机器人辅助下顺利完成腮腺良性肿瘤切除1例,手术顺利,面神经功能保存完好,术后创口愈合良好。     

Transoral robotic surgery for hilo-parenchymal submandibular stones: step-by-step description and reasoned approach

The conservative transoral approach to hilo-parenchymal submandibular stones has been proposed as an alternative to traditional sialadenectomy. The main purpose is to preserve the gland and eliminate the risk of a cervical scar and damage to the marginal mandibular branch of the facial nerve. The spread of transoral robotic surgery has favoured its application not only in the oropharynx, but also in the anterior oral cavity. This article describes a transoral robotic approach for hilo-parenchymal submandibular stones. In January 2019, two patients with a right and a left hilo-parenchymal submandibular stone of 15 mm and 8 mm, respectively, underwent removal of the stone with transoral robotic surgery using the Si Da Vinci surgical robot. The procedure was performed successfully and tolerated well, with a one-night hospitalization. There were no complications such as lingual nerve damage, painful gland swelling, infection, or ranula. The patients were followed up clinically and ultrasonographically for the first 3 months to verify symptom relief and persistence of stones; no symptoms or stones were found. The transoral robotic surgical approach seems to be safe and adequate for the conservative management of large hilo-parenchymal submandibular stones. An adequate diagnosis together with proper docking and an appropriate approach to the oral floor is mandatory.     

Transoral robotic approach for schwannoma of the larynx

We present a rare case of schwannoma of the supraglottic larynx in a 30-year-old woman with a 5-year history of dysphonia. Excision of the mass was performed by transoral robotic surgery (TORS) without complication using the robotic da Vinci Surgical System, 0-degree three-dimensional endoscope, 5-mm microinstruments compatible with the da Vinci robot, and an FK retractor. Transoral robotic surgery rendered good exposure that allowed complete tumor resection. An external approach and tracheotomy were not necessary in this case. We found that TORS was practicable, efficient, and nonhazardous for the resection of a supraglottic schwannoma. We propose TORS for the treatment of large benign and selected malignant laryngeal tumors.     

Transoral robotic surgery of parapharyngeal space tumours: a series of four cases

Tumours arising from the parapharyngeal space (PPS) represent less than 1% of all head and neck tumours. Salivary gland tumours account for 40–50% of PPS lesions and are located in the pre-styloid parapharyngeal space. Pleomorphic adenomas represent 80–90% of salivary tumours in the PPS. Recently, transoral robotic surgery (TORS) has become common in head and neck surgery as a minimally invasive procedure. Four cases of benign PPS tumour treated with TORS are presented here. Preoperative diagnosis was conducted by fine needle aspiration biopsy and magnetic resonance imaging, and the results were used to plan the correct surgical approach. One case required a change of approach to conventional transoral blunt dissection. Patients required pain control and reported dysphagia symptoms for a period of weeks, but no nasogastric tube was needed at any time. This case series indicates that TORS is a safe surgical procedure for the excision of benign tumours of the PPS in selected cases.     

Role of robotic surgery in oral and maxillofacial, and head and neck surgery

We review the current status of robotic surgery in the head and neck region and its role in oral and maxillofacial surgery.     

经口腔机器人手术在头颈外科中的应用

经口腔机器人手术(transoral robotic surgery,TORS)是近年来国际上头颈外科领域引人注目的一大进展,目前已成功应用于头颈-颅颌面肿瘤切除及游离皮瓣重建术。它突破了传统外科医师手术的概念,提高了手术质量,减小了手术创伤,极大地满足了患者的安全与美观需求,在头颈外科中的应用已被初步证实具有可行性和安全性。本文就TORS的组成、优点、应用现状及发展前景作一综述。     

Robotic surgery in oral and maxillofacial,craniofacial and head and neck surgery: A systematic review of the literature

A systematic review of the literature concerning robotic surgery in oral and maxillofacial (OMF), craniofacial and head and neck surgery was performed. The objective was to give a clear overview of the different anatomical areas of research in the field of OMF, craniofacial and head and neck surgery, in all its fields (pre-clinical and clinical). The present indications are outlined and the critical reader is invited to assess the value of this new technology by highlighting different relevant parameters. A PubMed and Cochrane library search yielded 838 papers published between 1994 and 2011. After screening the abstracts, 202 articles were considered clinically or technically relevant and were included. These full papers were screened in detail and classified as articles on synopsis (n = 41), educational aspects (n = 3), technical/practical aspects (n = 11) and clinical papers (n = 147). Regarding clinical feasibility this systematic review revealed the following main indications: transoral robotic surgery (TORS) for upper digestive and respiratory tract lesions; TORS for skull base surgery; and TORS for trans-axillary thyroid and endocrine surgery. Regarding functional outcome, this systematic review revealed a promising reduction of morbidity in patients with cancer of the upper digastric and respiratory tract.     

Oncological and functional outcomes of transoral robotic surgery for oropharyngeal cancer

In this prospective study we analysed the oncological and functional results of transoral robotic surgery (TORS) to find out if it was suitable as a minimally invasive treatment for oropharyngeal cancer. Between April 2008 and September 2011, 39 patients with oropharyngeal cancer were treated by TORS. We assessed overall and disease-free survival by the Kaplan–Meier test, and we used videopharyngography and the functional outcome swallowing scale (FOSS) to evaluate swallowing. We used nasometry to estimate hypernasality, and acoustic waveform analysis to evaluate the voice. Thirty-seven patients (95%) had histologically clear margins of resection. Overall survival at 2 years was 96% and disease-free survival 92%. An oral diet was tolerable after a mean of 6 (range 1–18) days. No serious swallowing difficulties were seen on the videopharyngogram. Thirty-six of 38 patients could swallow well (97%) with FOSS scores ranging from 0 to 2 (1 patient had a poor score but was able to take an oral diet after postural training). Voices were maintained close to the normal range on the acoustic waveform analysis. The oncological and functional results of TORS were quite acceptable for the treatment of oropharyngeal cancer. TORS is a valid treatment for selected patients with oropharyngeal cancer.     

加速康复外科在口腔癌患者术后早期康复中的应用效果评价

目的: 探讨加速康复外科（enhanced recovery after surgery, ERAS）在口腔癌患者术后早期康复中的应用效果。方法: 将2016年1月—2017年12月收治的90例口腔癌患者随机分为2组,试验组45例,术后行ERAS护理;对照组45例,术后给予常规护理。比较2组患者术后3 d日均睡眠时间,中度及以上疼痛及口臭发生情况;首次下床时间、术后住院时间;术后1、3 d前白蛋白等实验室指标。采用SPSS 17.0软件包对数据进行统计学分析。结果: ERAS干预后,术后1、3 d营养指标下降低于对照组;患者首次下床活动时间、术后住院天数均短于对照组,术后3 d睡眠时间长于对照组;发生口臭、伤口感染、中度疼痛的人次数低于对照组,差异有统计学意义（P<0.05）。结论: 口腔癌患者术后实施ERAS护理,可以提高患者舒适度,改善临床结局,促进患者快速康复,具有较好的临床应用前景。     

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计算机辅助外科是一种基于计算机对大量数据信息的高速处理及控制能力，通过虚拟手术环境为外科医生从技术上提供支援，使手术更安全、更准确的一门新技术。通过运用计算机辅助外科，可以优化手术方案、提供术中实时导航、提高手术的精确性和质量，使外科手术变得更为完美而富于严格的手术程序，从而降低手术危险性。本文主要介绍计算机辅助外科的基本原理、目前在临床上主要涉及的计算机辅助外科相关技术、这些技术的优缺点以及其在1：7腔颌面外科中的应用现状。     

监测麻醉对颌面外科手术患者围术期焦虑及疼痛程度的影响

目的:探讨围术期监测麻醉(montiored anesthetic care,MAC)对颌面外科手术患者围术期焦虑及疼痛程度的影响,以评价该技术在此类手术治疗中的价值。方法:颌面外科手术患者160例,随机分成局部麻醉组(LA组)和监测麻醉组(MAC组)各80例。预约手术后即刻让2组患者填写贝克焦虑量表,测定为预约后焦虑值;然后对2组患者均进行常规术前宣教和术前访谈,分别于术前30 min、术后30 min、术后第1天及术后第2天均进行一次焦虑值测评,并记录2组患者术后24 h后疼痛分级情况。结果:2组患者一般情况的比较差异无统计学意义(P>0.05)。组内不同时间点比较,LA组术前30 min和术后第2天,相比预约手术时的焦虑值明显降低;MAC组术前30 min、术后30 min、术后第1天及术后第2天,均比预约手术时的焦虑值明显降低(P<0.05)。LA组与MAC组行组间比较,在术后30 min、术后第1天时LA组焦虑值明显升高(P<0.05);MAC组较LA组患者术后疼痛明显减轻,差异有统计学意义(P<0.05)。结论:MAC能明显减轻颌面外科手术患者围术期焦虑及术后疼痛程度,利于手术的顺利进行和术后的恢复。