下咽食管狭窄的治疗  

The treatment for hypopharyngoesophageal stenosis

作　　者：张立强[1] 栾信庸[1] 潘新良[1] 解光[1] 许风雷[1] 刘大昱[1] 雷大鹏[1] 

机构地区：[1]山东医科大学附属医院耳鼻喉科,250012

出　　处：《山东医大基础医学院学报》2000年第4期221-224,共4页

摘　　要：目的 :探讨下咽食管狭窄的重建术 ,以取得更好的治疗效果。方法 :总结 35例下咽食管狭窄患者的治疗方法 ,包括类固醇激素和抗生素治疗、扩张治疗、下咽食管成形术 (胸大肌肌皮瓣、胸三角肌皮瓣、胸锁乳突肌皮瓣、全厚皮片、结肠上徙、胃上提、游离空肠、瘢痕切除局部粘膜减张缝合或纵切横缝 )。结果 :35例中 ,33例治愈 ,恢复正常饮食。经 1～ 19年的随访治愈病例未出现狭窄复发 ,疗效巩固。结论 :早期轻度的下咽食管狭窄可采用类固醇激素加抗生素治疗和扩张治疗 ,严重的下咽食管狭窄需行下咽食管成形术 ,局限于下咽部的狭窄在瘢痕切除后以胸大肌肌皮瓣或局部粘膜的纵切横缝整复 ,合并有食管狭窄者可以结肠上徙代食管术。胸大肌肌皮瓣和结肠不易感染坏死 ,手术成功率高 ,功能恢复满意 。Objective:In order to improve the curative effects of treatment on hypopharyngoesophageal stenosis.Method:35 patients with hypopharyngoesophageal stenosis were retrospectively reviewed.The curative methods were selected on the basis of different pathologic conditions,including using of steroids,antibacterial ,dilatation,reconstruction of hypopharynx and oesophagus with ectopectoralis musculocutaneous flap,thoracal deltoid muscle flap,sternocleidomastoid musculocutaneous flap,full thickness graft,colon and stomach interposition,free jejunal grafts,local mucous membrane flap.Result:With a follow up from 1 year to 19 years,33 patients resumed a normal oral diet and had no stenosis of anastomosis .Conclusions:For those who have the early mild lesions,using of steroids,antibacterial and dilatation are considered to be the choice procedure;for thos who have severe lesions,petforming reconstruction of hypopharynx and oesophagus is necessary.The ectopectoralis musculocutaneous flap or local mucous membrane flap is the first choice for treatig hypopharyngeal stenosis,while oesophageal reconstruction using the colon interposition can obtain good results.The ectopectoralis musculocutaneous flap and colon interposition are reliable and safe stuffs and appropriate to most of the hypopharyngoesophageal stenosis.

关 键 词：食管狭窄 咽狭窄 胸肌 外科皮瓣 结肠 治疗 

分 类 号：R655.405[医药卫生—外科学]