JAMA OHNS:达芬奇手术机器人对头颈肿瘤治疗的可能相当满意

2015-10-03 leaderbilly 译 MedSci原创

2000年7月11日,美国食品和药物管理局(FDA)批准了达芬奇手术系统,使其成为美国第一个可在手术室使用的机器人系统。达芬奇手术机器人治疗疾病的优势:1、达芬奇手术机器人拥有三维影像技术,可以向术者提供高清晰的三维影像,突破了人眼的极限,并且能够将手术部位放大10-15倍,使手术的效果更加精准。2、达芬奇手术机器人的机器手臂非常灵活,而且具有无法比拟的稳定性及精确度,能够完成各类高难度的精细手术

2000年7月11日,美国食品和药物管理局(FDA)批准了达芬奇手术系统,使其成为美国第一个可在手术室使用的机器人系统。达芬奇手术机器人治疗疾病的优势:1、达芬奇手术机器人拥有三维影像技术,可以向术者提供高清晰的三维影像,突破了人眼的极限,并且能够将手术部位放大10-15倍,使手术的效果更加精准。2、达芬奇手术机器人的机器手臂非常灵活,而且具有无法比拟的稳定性及精确度,能够完成各类高难度的精细手术。3、达芬奇手术机器人治疗疾病创伤非常小,不需要开腹,手术创口仅在1厘米左右,大大减少了患者的失血量及术后疼痛,住院时间也明显缩短,有利于术后的康复。基于上述方面的优势,达芬奇手术机器人开始在全球范围内推广,并越来越多地应用到临床实践工作中。

尽管达芬奇机器人手术进入临床已经有一段时间,但是对于经口机器人手术(TORS)在头颈部肿瘤治疗方面的有效性,需要大规模的队列研究来证实。为了进一步认识TORS对肿瘤预后的影响,来自加拿大、美国、比利时以及韩国的多个研究中心的研究人员共同对此进行了研究。该项研究结果在线发表在今年9月的JAMA Otolaryngol Head Neck Surg杂志上。


该项研究回顾了从2007年1月1日至2012年12月31日期间接受TORS治疗咽喉肿瘤的410名患者的情况。这些患者的数据来自11个参与本研究的医疗研究中心。在接受TORS治疗前/后,患者可选择接受放射治疗和/或化疗。

在这项研究入组的410名患者中,364名(88.8%)为口咽癌患者。而在这364名患者中,已知接受术后辅助治疗有338名,其中106名(31.3)仅接受放射治疗,而72名(21.3%)接受了放疗联合化疗。进行颈部切开的占323例(78.8%)。平均随访时间是20个月。在这410名患者中,原位复发、局部复发和远处转移的分布有18例(4.4%)、15例(3.7%)和10例(2.4%)。17例(4.1%)死于该疾病,13例(3.2%)死于其他原因。2年局部区域控制率为91.8%(95%置信区间为87.6%-94.7%),疾病特异性存活率为94.5%(95%置信区间为86.5-94.0%),而总体生存率为91%(95%置信区间为86.5-94.0%)。多变量分析显示女性患者以及扁桃体肿瘤患者接受手术后生存率显著提高(P值分别为0.05和0.01)。

研究人员指出,这个多机构研究的为TORS在头部和颈部癌症的多学科治疗治疗中的角色阐述提供了有力的支持,尤其是对于口咽癌的治疗。由国家癌症研究所NCI所资助的临床试验将进一步评估达芬奇机器人手术在头部和颈部癌症治疗中的角色。
 
原始出处:
de Almeida JR, Li R, Magnuson J, et al.Oncologic Outcomes After Transoral Robotic Surgery : A Multi-institutionalStudy. JAMA Otolaryngol Head Neck Surg. Published online September 24, 2015. doi:10.1001/jamaoto.2015.1508.

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