喉-气管组织瓣重建下咽癌累及颈段食管术后缺损  

Laryngo-tracheal flap to reconstruct the defect after resection of the hypopharyngeal carcinoma with cervical esophagus involvement

作　　者：李文[1] 杨柳[1] 陈敏[1] 祝佼[1] 袁莉清 辜德英[1] 

机构地区：[1]四川大学华西医院耳鼻咽喉头颈外科,成都610041

出　　处：《临床耳鼻咽喉头颈外科杂志》2014年第24期1945-1948,共4页Journal of Clinical Otorhinolaryngology Head And Neck Surgery

摘　　要：目的：探讨利用喉-气管组织瓣重建颈段食管的方法。方法：下咽癌累及颈段食管患者11例中,肿瘤累及一侧梨状窝及颈段食管8例,累及双侧梨状窝、咽后壁及颈段食管3例。手术完整切除咽喉及颈段食管病变,同期行双侧颈清扫。对喉及气管环状结构能完整保留者（3/11）,直接与口咽部及病变下端颈胸段食管吻合;对咽喉部分保留者（8/11）,作胸大肌肌皮瓣与之对合重建颈段食管。术后行放化疗,随访1～5年。结果：术后1例咽瘘、1例乳糜瘘,经2周左右换药痊愈。11例患者术后均正常进食,无吻合口狭窄。6例患者术后随访3年无复发,4例放疗半年后颈部出现淋巴结转移,1例术后1年胸段食管癌伴肝转移未治失访。3年生存率为54.5%。结论：喉气管组织瓣重建下咽癌累及颈段食管切除术后颈段食管是一种制作过程简单、效果确实、术后并发症少的修复重建方法。Objective：To investigate cervical esophageal reconstruction by means of laryngo-tracheal flap after resection of hypopharyngeal carcinoma with cervical esophageal involvement. Method： Eleven cases of hypopharyn- geal carcinoma with cervical esophageal involvement. Unilateral piriform sinus and cervical esophagus were in- volved in 8 cases （8/11） while bilateral piriform sinus, posterior pharyngeal wall and cervical esophagus were in- volved in 3 cases. After resection of laryngeal, pharyngeal and esophageal tumors and bilateral neck dissection, di- rect anastomosis of larynx and trachea with esophagus of cervico-thoracic segment was performed if circular struc- ture of larynx and trachea could be preserved （3/11）, pectoralis major myocutaneous flap was employed if only part of pharynx and larynx could be preserved （8/11）. Postoperative radiochemotherapy was adopted and follow- up lasted for 1-5 years. Result：All cases healed without event except for one case of pharyngeal fistula and one case of chylous fistula which also healed after about 2 weeks dressing change. All patients got normal diet without anastomotic stricture. There was no recurrence in 6 patients at the 3 years follow-up, 4 patients had metastases in the neck and 1 patient had thoracic esophageal carcinoma with hepatic metastasis and gave up further treatment. The overall 3-year survival rate was 54.5 %. Conclusion：Using laryngo-tracheal flap to reconstruct cervical esoph- agus after resection of hypopharyngeal carcinoma with cervical esophageal involvement is a recommendable method that is simple in processing, reliable in effect and less in postoperative complications.

关 键 词：下咽肿瘤 食管 修复外科手术 

分 类 号：R739.63[医药卫生—肿瘤]