经口舌根病变外科治疗中术野显露的瓶颈与技术演进

Limitations in surgical exposure and technical evolution of transoral surgical treatment for tongue base lesions

摘要:

舌根病变位置深在，解剖结构复杂，毗邻气道与吞咽关键功能区域，术野显露困难是长期制约其外科治疗安全性与切除彻底性的核心瓶颈。传统开放手术创伤大，术后外观美容效果差；激光与低温等离子技术虽显著提升了微创水平，但仍难以突破深部显露与操作盲区的限制。经口机器人手术（TORS）凭借三维高清视野、灵活机械臂及精准操作优势，为改善舌根深部术野显露、提高复杂舌根病变切除的安全性提供了新的技术平台。本文围绕舌根病变经口入路手术的显露难点、主要技术路径及发展趋势进行阐述，以期为临床术式选择和规范化治疗提供理论参考。

Abstract:

Tongue base lesions are located deep within the oropharynx with intricate adjacent anatomical structures, and they border critical functional regions responsible for airway maintenance and swallowing. Poor surgical field exposure has long been the core bottleneck restricting the safety and radicality of surgical management for such lesions. Conventional open surgery involves significant trauma and results in unsatisfactory cosmetic outcomes. Although laser and coblation technologies have greatly advanced minimally invasive treatment, they still fail to overcome limitations regarding deep surgical visualization and blind operating zones. Transoral robotic surgery (TORS), leveraging its advantages of three-dimensional high-definition visualization, flexible robotic arms, and precise manipulation, offers a novel technical platform for improving exposure of deep lingual lesions and enhancing the safety of resection of complex tongue base lesions. This commentary reviews the exposure challenges, mainstream technical approaches and developmental trends of transoral surgery for tongue base lesions, aiming to provide theoretical references for surgical procedure selection and standardized therapeutic protocols.