单孔与多孔经口机器人手术治疗上气道疾病术后出血及围手术期结局的比较

文献信息

中文摘要

背景： 经口机器人手术（TORS）的整合推动了上气道病变管理的范式转变；然而，下一代单孔（SP）平台与传统多孔系统之间多方面的操作差异值得全面研究。本回顾性分析深入探讨了126例通过Si、Xi和SP平台接受TORS患者的围手术期指标和术后出血情况。方法：手术按复杂性分为单平面或多平面。为减轻基线混杂因素，我们构建了多平面病例的倾向匹配队列（每个平台n=21）。结果：总体而言，9.5%的队列发生重大术后出血。正如预期，多平面干预显著增加了手术时间、术后疼痛和住院时间。在未匹配分析中，SP平台表现出稳健的安全性特征，总体出血率仅为3.1%（单平面0%；多平面4.8%），与Si和Xi队列中较高的发生率形成对比。在精细匹配的多平面亚组中，与Xi平台相比，SP系统显示重大出血事件显著更少（4.8% vs. 28.6%）。关键的是，这种协同作用不能仅归因于机器人机械特性，因为匹配的SP病例普遍使用了局部止血剂。探索性分层Firth惩罚逻辑回归表明，纳入机器人平台显著增强了预测模型（Firth p=0.048），表明SP平台与出血几率降低相关（调整比值比=0.22）。结论：最终，这一有力证据揭示了SP系统在复杂气道重建中优化安全性的潜力，需要未来标准化的前瞻性试验。

英文摘要

The integration of transoral robotic surgery (TORS) has catalyzed a paradigm shift in the management of upper airway pathologies; however, the multifaceted operational distinctions between next-generation single-port (SP) platforms and conventional multi-port systems warrant comprehensive investigation. This retrospective analysis delves into the perioperative metrics and postoperative hemorrhage profiles of 126 patients undergoing TORS via the Si, Xi, and SP platforms. Procedures were categorized by complexity as single- or multilevel. To mitigate baseline confounders, we engineered a propensity-matched cohort of multilevel cases (n = 21 per platform). Overall, major postoperative hemorrhage manifested in 9.5% of the cohort. As anticipated, multilevel interventions underscored significant increases in operative duration, postoperative pain, and hospitalization length. In our unmatched analysis, the SP platform demonstrated a robust safety profile, yielding an overall hemorrhage rate of merely 3.1% (0% in single-level; 4.8% in multilevel), contrasting with higher incidences in the Si and Xi cohorts. Within the intricately matched multilevel subset, the SP system showcased significantly fewer major hemorrhage events compared to the Xi platform (4.8% vs. 28.6%). Crucially, this synergy cannot be solely attributed to robotic mechanics, as topical hemostatic agents were universally leveraged in matched SP cases. Exploratory hierarchical Firth penalized logistic regression illuminated that incorporating the robotic platform significantly augmented the predictive model (Firth p = 0.048), indicating the SP platform is associated with reduced hemorrhage odds (adjusted odds ratio = 0.22). Ultimately, this compelling evidence sheds light on the SP system's potential to optimize safety in complex airway reconstruction, necessitating future standardized prospective trials.