Objective To evaluate the safety,efficacy,and long-term outcomes of transoral ro-botic surgery(TORS)for the resection of parapharyngeal space tumors(PPST).Methods A retro-spective analysis was conducted on clinical data from 16 patients who underwent TORS for PPST re-section.Surgical outcomes,postoperative pathological findings,and complication rates were ob-served.Follow-up evaluations were performed to assess patient satisfaction,swallowing function re-covery,and tumor recurrence.Results Except for one patient who required an additional neck inci-sion,the remaining 15 patients successfully completed the surgery via the oral route.None of the pa-tients underwent tracheotomy or mandibulotomy.The mean surgical duration was 43.9 minutes,with an average tumor diameter of 4.5 cm resected.The mean intraoperative blood loss was 35.3 mL.Patients resumed oral intake after an average of 3.8 days and had a mean postoperative hospital stay of 8.3 days.Postoperative pathological examination revealed that the most common tumor type was pleomorphic adenoma(56.2％,9/16),followed by schwannoma(25.0％,4/16),with one case of basal cell adenoma,cyst,and lipoma,respectively.One patient experienced transient Horner's syndrome,two had wound dehiscence that healed spontaneously,and one had spontaneous wound healing after drainage tube dislodgement.With a mean follow-up of 79.5 months,no tumor recurrence or severe complications were observed.All patients had good swallowing function and were satisfied with the surgical outcomes.Conclusion TORS for PPST resection offers advantages such as clear surgical visualization,direct surgical access,minimal blood loss,reduced trauma,favorable cosmetic re-sults,and rapid postoperative recovery.It also demonstrates good long-term outcomes,with high safety and efficacy.

Objective? To study the clinical observation and nursing strategies for myelosuppression caused by induction chemotherapy for stage Ⅲ and stage Ⅳ laryngeal and hypopharyngeal cancers. Methods? The clinical data of 8 patients admitted during March 2015 to June 2017 who developed myelosuppression after induction chemotherapy using taxol + cisplatin + fluorouracil (TPF) were retrospectively analyzed for nursing strategies. Key nursing strategies included in the analysis were basic care, psychological care, condition observation and monitoring, medication care, infection prevention, infection management, prevention and treatment of anemia and bleeding, diet care and activity care. Results? After induction chemotherapy, 8 out of 15 (53.33%) stage Ⅲ and stage Ⅳ laryngeal and hypopharyngeal cancer patients developed myelosuppression, among which 3 patients showedⅢ-Ⅳ degree myelosuppression. Granulocyte colony stimulating factor (CSF) was administered by intramuscular injection to manage reduced granulocyte level in 2 cases. The granulocyte level in both patients went back to normal after 3-5 days. Platelet and recombinant human thrombopoietin were administered by intravenous injection to manage reduced platelet in 1 case. The platelet level of the patient started to increase after 3 days. All patients successfully recovered from myelosuppression before being discharged. Conclusions? For stageⅢ and stageⅣ laryngeal and hypopharyngeal cancer patients who developed myelosuppression after chemotherapy, enhanced basic care, psychological care and close observation of condition developments are essential to the patients' smooth recovery from myelosuppression.

Objective: To explore the perioperative clinical treatment of thyroid cancer patients with heart disease. Methods: A retrospective analysis was conducted on 39 thyroid cancer patients with heart disease admitted to the Department of Otorhinolaryngology Head and Neck Surgery, Beijing Anzhen Hospital,Capital Medical University from April 2014 to February 2018,including 25 males and 14 females, the age ranged from 59 to 75 years,with an average age of 67.3±6.2 years. Perioperative clinical monitoring indicators included cardiac ultrasound left ventricular ejection fraction (LVEF), degree of vascular stenosis revealed by coronary CT, hypersensitive troponin I (TNI), b-type natriuretic peptide (BNP), fibrinogen degradation products,and coagulation indexes. This panel of patients comprised 26 cases with 50% ≤ LVEF<60%,10 cases with 40% ≤ LVEF<50%, 3 cases with 36% ≤ LVEF<40%, 27 cases with 0≤BNP<100 ng/L, 7 cases with 100≤BNP<400 ng/L, and 5 cases with 400≤BNP<700 ng/L. Coronary CT showed no coronary artery stenosis>75%. The vascular graft was patent and the coronary artery after stenting was unobstructed. For 3 patients with LVEF<40% and 5 patients with BNP>400 ng/L,cardiotonic,diuretic,and nutritional myocardial therapy were used for 1 week. SPSS 17.0 software was used to analyze the data. Results: All 39 patients successfully completed the operation under general anesthesia,including 32 cases of total thyroidectomy,7 cases of glandular lobe and isthmic resection,and 40 cases of lateral neck dissection. One patient developed heart failure three days after surgery and was discharged after two weeks of treatment. No other cardiac related events,cerebrovascular and pulmonary thrombosis occurred during the perioperative period. The anesthesia preparation time was significant different between the group with 0≤BNP<100 ng/L and 50%≤LVEF<60% and the group with 0≤BNP<100 ng/L and 36%≤LVEF<50%. Conclusions Multi-indicators were utilized to adequately assess cardiac function before surgery. According to the results of cardiac ultrasound and coronary CT examination, the corresponding treatment should be conducted to improve the cardiac function. After the perioperative risk assessment and management of thyroid cancer patients with heart disease,standardized thyroid cancer surgery can be performed safely.

Objective To explore the perioperative clinical treatment of thyroid cancer patients with heart disease. Methods A retrospective analysis was conducted on 39 thyroid cancer patients with heart disease admitted to the Department of Otorhinolaryngology Head and Neck Surgery, Beijing Anzhen Hospital, Capital Medical University from April 2014 to February 2018, including 25 males and 14 females, the age ranged from 59 to 75 years, with an average age of 67.3 ± 6.2 years. Perioperative clinical monitoring indicators included cardiac ultrasound left ventricular ejection fraction (LVEF), degree of vascular stenosis revealed by coronary CT, hypersensitive troponin I (TNI), b-type natriuretic peptide (BNP), fibrinogen degradation products, and coagulation indexes. This panel of patients comprised 26 cases with 50％ ≤LVEF<60％, 10 cases with 40％ ≤ LVEF<50％, 3 cases with 36％≤LVEF<40％, 27 cases with 0≤BNP<100 ng/L, 7 cases with 100≤BNP<400 ng/L, and 5 cases with 400≤BNP<700 ng/L. Coronary CT showed no coronary artery stenosis>75％. The vascular graft was patent and the coronary artery after stenting was unobstructed. For 3 patients with LVEF<40％ and 5 patients with BNP>400 ng/L,cardiotonic,diuretic,and nutritional myocardial therapy were used for 1 week. SPSS 17.0 software was used to analyze the data. Results All 39 patients successfully completed the operation under general anesthesia,including 32 cases of total thyroidectomy,7 cases of glandular lobe and isthmic resection,and 40 cases of lateral neck dissection. One patient developed heart failure three days after surgery and was discharged after two weeks of treatment . No other cardiac related events,cerebrovascular and pulmonary thrombosis occurred during the perioperative period. The anesthesia preparation time was significant different between the group with 0≤BNP<100 ng/L and 50％≤LVEF<60％ and the group with 0≤BNP<100 ng / L and 36％≤LVEF<50％. Conclusions Multi-indicators were utilized to adequately assess cardiac function before surgery. According to the results of cardiac ultrasound and coronary CT examination, the corresponding treatment should be conducted to improve the cardiac function. After the perioperative risk assessment and management of thyroid cancer patients with heart disease,standardized thyroid cancer surgery can be performed safely.

Objective: To investigate the indication, feasibility, and safety of da Vinci robotic surgical system in pharyngolaryngeal tumor resection. Methods: Thirty patients were diagnosed with pharyngolaryngeal tumors and treated with a transoral robotic surgery (TORS) in Beijing Anzhen Hospital from June 1, 2016 through November 30, 2017. Inclusion criteria included lesions of the oropharynx (n=13), parapharyngeal space (n=7), larynx (n=6) and hypopharynx (n=4). Twenty cases were males and ten cases were females. The median age was 56 years old (ranging from 30 to 81 years). Results: The robotic surgeries were performed successfully on 30 patients. One patient (3.3%) underwent TORS combined with a neck incision. The mean operative time was 40.7 min. The mean blood loss was 15.8 ml. The mean recovery time for oral intake was 5.3 days. The mean hospital stay was 9 days. None of the patients underwent tracheotomy or mandible split. Postoperative pathological examination showed that 18 cases (60.0%) were malignant and 1 case (5.6%) had positive surgical margin. Sixteen cases received neck dissection. No serious complications occurred during or after the operation. There was no local recurrence, metastasis or death except for regional recurrences in 2 cases (11.1%) with a follow-up of 1 to 18 months(median 13 months). Conclusion Transoral robotic surgery is a feasible, safe and effective surgical procedure with clear operation field, rapid surgical access, minimally invasive surgery, lesser hemorrhage, good cosmetic effect and fast recovery.