游离空肠移植重建下咽及颈段食管的临床分析  

Reconstruction with free jejunal interposition for defect after tumor resection of hypopharyngeal and cervical esophageal cancer

作　　者：赵德安[1] 高兴强[1] 

机构地区：[1]福建医科大学附属厦门第一医院耳鼻咽喉-头颈外科,361003

出　　处：《中国临床实用医学》2009年第6期29-30,共2页China Clinical Practical Medicine

摘　　要：目的探讨游离空肠修复下咽及颈段食管肿瘤切除术后组织缺损的方法和疗效。方法回顾性分析采用游离空肠重建下咽颈段食管7例，为下咽癌侵及颈段食管，均行全喉、下咽及颈段食管切除。术前均行x线食管造影及胃镜检查，了解病变范围，术后复查x线食管造影。术后均补充放疗。随访7个月～24个月。结果本组7例患者移植游离空肠全部成活。1例于术后13d发现咽瘘，经换药、抗炎等处理后18d痊愈。1例患者于术后95d无明确诱因出现上消化道大出血死亡。1例患者术后5个月出现进食困难，发现胸段食管癌，放弃治疗于术后11个月死亡。5例患者随访至今游离空肠均成活良好，无吻合口狭窄及进食困难。结论以游离空肠修复下咽及颈段食管部位肿瘤切除术所致缺损，并发症较少，成功率高，恢复消化道的连续性安全可靠。Objective To discuss the use of free jejunal flap reconstruction for circumferential defect after tumor resection of hypopharyngeal and cervical esophageal cancer. Methods Retrospective review of 7 pa- tients who underwent hypopharyngeal and cervical esophageal reconstruction with free jejunal interposition from 2005 to 2007. All 7 cases who suffered from hypopharyngeal and cervical esophageal cancer were given resection of the larynx, hypopharynx and cervical esophagus. Neck dissection and postoperative radiotherapy were carried out for all patients. Results All the 7 free jejunal flaps survived completely and the flap success rate was 100%. For successful cases, one case occurred pharyngeal fistula on postoperative thirteenth day and healed on postoperative eighteenth day, One patient was died of the gastrointestinal bleeding on postoperative ninety-five day. one patient couldn＇ t swallow after five months because of recurrence of pectoral esophageal cancer and died after eleven months. Follow-up 7 to 24 months, five survived cases were no recurrence and dysphagia. Conclu- sion Patients reconstructed with free jejunal flap after resection of hypopharyngeal and cervical esophageal cancer had high successful rate and few complications. The choice of free jejunal flap for reconstruction of hypo-pnharyngeal and cervical esophageal defect was appropriate in selected patients.

关 键 词：下咽肿瘤 食管肿瘤 游离空肠瓣 修复外科手术 

分 类 号：R735.1[医药卫生—肿瘤]