喉咽及颈段食管癌外科切除后上消化道重建  

Upper alimentary tract reconstruction after resection of hypopharyngeal and cervical esophageal cancers

作　　者：李树春[1] 李振东[1] 徐成钧[1] 刘文中[1] 曾威[1] 董慧蕾[1] 

机构地区：[1]辽宁省肿瘤医院头颈外科,辽宁沈阳110042

出　　处：《中国耳鼻咽喉头颈外科》2011年第5期227-230,共4页Chinese Archives of Otolaryngology-Head and Neck Surgery

摘　　要：目的探讨喉咽及颈段食管癌病变切除后上消化道重建方式的合理性、有效性以及存在的问题。方法回顾性分析我科自1984～2008年共计308例喉咽及颈段食管癌患者临床资料,其中男性258例,女性50例,喉咽癌278例(梨状窝224例、环后18例及喉咽后壁36例),颈段食管癌30例。I期19例,II期52例,III期117例,IV期120例,全部患者均经手术治疗。308例患者分别应用胃上提代食管术、结肠上徙代食管术、游离空肠移植代食管术、游离组织瓣、带蒂胸大肌肌皮瓣、复合喉气管与胸大肌皮瓣以及喉气管瓣及喉咽黏膜关闭等重建上消化道,其中有51例保留或重建了发音功能(有36例为喉部分切除)。结果 308例患者经手术治疗后于短期内恢复经口进食功能者为298例,占全部病例的96.7%。恢复和保存发音功能者共计51例,占全部病例的16.6%,36例喉部分切除者中有21例拔除了气管套管。手术死亡5例,占1.6%,咽瘘、移植物脱落等并发症共计57例,占18.5%。全组1、3、5年生存率分别为79.6%、60.2%和40.7%。结论喉咽及颈段食管癌目前的治疗方法仍以外科广泛切除并配合必要的上消化道重建术,以及手术前、后放射的综合治疗为主要手段,对于部分选择的病例可同时保留或重建发音功能。上消化道重建方法是有效和可靠的,可根据不同患者具体情况选择应用。某些胸上段食管癌可选择应用食管内翻拔脱切除,上提胃行颈段食管胃吻合术治疗,喉部分及喉咽切除应用游离组织瓣重建效果优于肌皮瓣。OBJECTIVE To study the rationality and effectiveness of reconstruction methods for the defects after resection of the hypopharengeal and cervical esophageal cancers.METHODS The clinical data of 308 consecutive patients with hypopharyngeal and cervical esophageal cancers from 1985 to 2008 were retrospectively studied.There were 258 male and 50 female.The clinical diagnosis was 278 cases with hypopharyngeal cancer（pyriform sinus 224 cases,postcricoid 18 cases and posterior hypopharyngeal wall 36 cases）and 30 cases with cervical esophagealcancer.According to the classification of AJCC 2002,there were 19 cases in stage I,52 cases in stage II,117 cases in stage III and 120 cases in stage IV.All of the patients underwent surgical treatment.The upper alimentary tract were reconstructed by gastric pull-up,colon interposition,free jejunal interposition,free flap,pectoralis major myocutaneous flap,complex laryngo-trcheal myocutaneous flaps or hypopharyngeal mucosa.Fifty one patients preserved or reconstructed the voice function（included 36 patients with partial laryngectomy）.RESULTS Two hundred and ninety eight of 308 cases resumed the oral diet soon after operation（96.7%）.The voice function resumed or preserved in 51 cases（16.6%）.Twenty one of 36 patients after partial laryngectomy were decannulated.Five cases（1.6%）were died in perioperative period.The operative complications included pharyngeal fistula and transplanting flaps lost occurred in 57 cases （18.5%）.The 1,3,and 5 year survival rates were 79.6%,function.Freeflap is better than myocutaneous flap for the reconstruction of the defects after laryngectomy and hypopharyngectomy.60.2%and 40.7%respectively.CONCLUSION Up to now,extensive surgical resection and necessary upper alimentary tract reconstruction is the main method for hypopharyngeal and cervical esophageal cancers.Some cases can be reconstructed or preserved the voice

关 键 词：下咽 食管 癌 鳞状细胞 修复外科手术 上消化道 

分 类 号：R735.1[医药卫生—肿瘤]