游离空肠移植术后再手术时对血管蒂的保护  

Protection of the Vascular Pedicles during Re-operation after Free Jejunal Transplantation

作　　者：张先强[1] 李文[2] 王奕娟[2] 李慧[2] 吴春树[2] 

机构地区：[1]内江市东兴区人民医院耳鼻喉科,四川内江641100 [2]四川大学华西医院耳鼻喉科

出　　处：《华西医学》2011年第3期372-374,共3页West China Medical Journal

摘　　要：目的观察全喉全下咽切除术后空肠游离移植术二次手术时同时保留动静脉血管蒂或仅保留动脉血管蒂时对移植组织的影响。方法回顾分析2002年1月-2009年12月4例下咽癌行全喉全下咽切除术空肠游离移植术术后8～18个月因颈部转移灶出现而需再行手术患者的临床资料,其中3例行根治性颈清扫,1例行局部包块扩大切除术。2例同时保留动静脉蒂,2例仅保留动脉蒂。结果 4例术后临床Ⅰ期愈合。保留动静脉蒂者吞咽功能与术前无异。仅保留动脉蒂者术后1个月仍有颈中份的明显隐痛,胃肠造影移植空肠段的蠕动明显减弱,吞咽固体食物时自觉较术前缓慢。结论再次手术时保留血管蒂对于保持空肠移植段的活力具有重要的意义。Objective To observe the effect of keeping arteriovenous or venous pedicles during the second free jejunal transplantation after total laryngopharyngectomy on the transplanted tissues.Methods From January 2002 to December 2009,four patients underwent total laryngopharyngectomy and free jejunal.But 8-18 months later,the patients underwent another operation because of recurrent metastatic mass in the ipsilateral neck side of anastomosis;in whom three underwent radical neck dissection and one underwent local enlarged mass resection.In the four patients,two had arteriovenous pedicles remained and another two kept only venous pedicles.Results All of the four patients experienced first-stage healing.The deglutitive function in the two patients who had received the arteriovenous pedicles preservation didn’t differ much from that before the operation.While vague anguish in the anterior region of the neck,weak peristalsis of the transplanted jejunum,a little discomfort and slow swallowing were found in another two patients.Conclusion Keeping vascular pedicles during re-operation helps make the activity of the transplanted jejunum.

关 键 词：下咽癌 空肠游离将植 重建 复发 

分 类 号：R739.6[医药卫生—肿瘤] R616.2[医药卫生—临床医学]