经口机器人辅助下利用上臂皮瓣重建多形性腺癌切除后腭后部缺损：一种新型微创方法。

文献信息

中文摘要

背景： 口腔颌面部恶性肿瘤的手术治疗常需广泛切除，导致显著的功能和美学并发症。在年轻患者中，这些后遗症带来沉重的心理社会负担，强调需要既能保持生活质量又能维持肿瘤学安全的微创重建策略。
病例介绍： 一名36岁女性患者，左侧硬腭与软腭交界处出现一个1×1 cm的小肿胀。切开活检证实为恶性小唾液腺肿瘤，但无法确定具体亚型。最终诊断的多形性腺癌（PAC），经典型，仅在完整切除标本上确立。在肿瘤学充分切除后，包括部分硬腭和腭结节切除，一个3×4 cm的缺损用游离上臂皮瓣重建。通过经口入路，使用Symani®机器人手术系统，以20倍运动缩放，对上唇动脉和面动脉（血管直径约0.2 mm）进行超显微血管吻合。静脉吻合至面静脉，通过相同的口内入路完成端对端和端对侧吻合。通过最小颈部切口对四个影像学上突出的同侧II区淋巴结进行选择性淋巴结取样，冰冻切片和最终组织病理学均显示无转移（0/4）。最终组织病理学显示一个15 mm低级别PAC，切除干净，无淋巴血管侵犯，无明确神经周围浸润，无骨侵犯，分类为pT1 pN0 (0/4) cM0，R0。术后过程顺利；包括言语和吞咽治疗的功能康复正在进行中。
结论： 使用Symani®系统的机器人辅助超显微手术使得经口游离皮瓣重建腭后部缺损成为可能，吻合口在亚0.2 mm尺度。这种方法最小化了供区并发症，并展示了口内机器人超显微手术作为头颈肿瘤学中一种新型重建模式的可行性。

英文摘要

BACKGROUND: Surgical management of malignant tumors in the orofacial region frequently necessitates extensive resection, resulting in significant functional and aesthetic morbidity. In younger patients, these sequelae carry a substantial psychosocial burden, emphasizing the need for minimally invasive reconstructive strategies that preserve quality of life while maintaining oncological safety.
CASE PRESENTATION: A 36-year-old female patient presented with a small 1 × 1 cm swelling at the junction of the hard and soft palate on the left side. Incisional biopsy confirmed a malignant minor salivary gland tumor but did not permit definitive subtyping. The final diagnosis of a polymorphous adenocarcinoma (PAC), conventional subtype, was established only on the complete resection specimen. Following oncologically adequate resection, including partial hard palate and tuberosity removal, a 3 × 4 cm defect was reconstructed with a free upper arm flap. Supermicrovascular anastomoses to the superior labial and facial arteries (vessel diameter ~ 0.2 mm) were performed via a transoral approach using the Symani® robotic surgical system with 20× motion scaling. Venous anastomoses to the facial vein were completed end-to-end and end-to-side via the same intraoral access. Selective lymph node sampling of the four radiologically prominent ipsilateral level II lymph nodes through a minimal cervical incision showed no metastases, both on frozen section and on final histopathology (0/4). Final histopathology demonstrated a 15 mm low-grade PAC resected in sano, without lymphovascular invasion, without unequivocal perineural infiltration and without bone invasion, classified as pT1 pN0 (0/4) cM0, R0. Postoperative course was uneventful; functional rehabilitation including speech and swallowing therapy is ongoing.
CONCLUSIONS: Robotic-assisted supermicrosurgery using the Symani® system enabled safe transoral free flap reconstruction of a posterior palatal defect with anastomoses at the sub 0.2 mm scale. This approach minimizes donor-site morbidity and demonstrates the feasibility of intraoral robotic supermicrosurgery as a novel reconstructive modality in head and neck oncology.