背景:微创手术是当今耳鼻喉科外科医生的主要挑战,他们的目标是在美学和功能影响较小的情况下实现肿瘤的激进性。这是广泛的经口外科技术的基础,作为Thunderbeat®。
目标:迄今为止,Thunderbeat®在经口手术中的使用仍然鲜为人知和广泛。所以,这项研究分析了,通过系统的审查,关于Thunderbeat®经口使用的最新文献,并展示了我们的案例研究。
方法:研究是在Pubmed,Scopus,使用特定关键字的WebofScience和Cochrane数据库。然后,在我们的耳鼻喉科诊所对10例接受Thunderbeat®经口手术的患者进行了回顾性研究.在我们的案例和系统评价中,已经评估了以下参数:治疗的解剖部位和亚部位,组织学诊断,手术类型,鼻胃管和住院时间,术后并发症,气管造口术,切除边缘状态。
结果:该综述包括3篇文章,描述了经口使用Thunderbeat®治疗总共31例口咽部患者,下咽和/或喉癌。平均21.5天后取出鼻胃管,6例患者进行了临时气管切开术.主要并发症为出血(12.90%)和咽瘘(29.03%)。Thunderbeat®轴长35cm,大5mm。我们的案例研究包括5名男性和5名女性,平均年龄64.4±10.28,口咽或声门上癌,舌根咽旁多形性腺瘤和海绵状血管瘤。对8例患者进行了临时气管切开术。所有病例均获得了自由切除边缘(100%)。无围手术期并发症发生。平均5.3±2天后拔除鼻胃管。所有患者均于平均18.2±4.72d后出院,无气管导管和NGT。
结论:这项研究表明,Thunderbeat®与其他经口手术方法相比具有若干优势,如CO2激光和机器人手术,在肿瘤和功能成功的最佳结合方面,术后并发症和费用较少。所以,这可能代表了经口手术的进步。
BACKGROUND: Minimally invasive surgery is today the main challenge of ENT surgeons who aim to achieve oncological radicality with less aesthetic and functional impact. This is the basis for the widespread transoral surgical techniques, as the Thunderbeat®.
OBJECTIVE: To date, the use of Thunderbeat® in transoral surgery is still little known and widespread. So, this study analyzes, with a systematic
review, current literature about the transoral use of Thunderbeat® and shows our case studies.
METHODS: The research was carried out on Pubmed, Scopus, Web of Science and Cochrane databases using specific keywords. Then, a retrospective study was carried out on 10 patients who underwent transoral surgery by Thunderbeat® in our ENT Clinic. Both in our cases and in the systematic
review the following parameters have been evaluated: treated anatomical site and subsite, histological diagnosis, type of surgery, duration of nasogastric tube and hospitalization, post-operative complications, tracheostomy, resection margin status.
RESULTS: The
review included 3 articles that described transoral use of Thunderbeat® for a total of 31 patients suffering from oropharyngeal, hypopharyngeal and/or laryngeal carcinoma. Nasogastric tube was removed after 21.5 days on average, temporary tracheostomy was performed in 6 patients. The main complications were: bleeding (12.90%) and pharyngocutaneous fistula (29.03%). Thunderbeat® shaft was 35 cm long and 5 mm large. Our case studies included 5 males and 5 females, mean age 64.4 ± 10.28, with oropharyngeal or supraglottic carcinoma, parapharyngeal pleomorphic adenoma and cavernous hemangioma of the tongue base. Temporary tracheostomy was performed in 8 patients. Free resection margins were achieved in all cases (100%). No peri-operative complications occurred. Nasogastric tube was removed after 5.3 ± 2 days on average. All patients were discharged without tracheal tube and NGT after 18.2 ± 4.72 days on average.
CONCLUSIONS: This study demonstrated that Thunderbeat® has several advantages over other transoral surgical approaches, such as CO2 laser and robotic surgery, in terms of best combination of oncological and functional success, less post-operative complications and costs. So, it could represent a step forward in transoral surgery.