经口内镜微创外科治疗环后区和食管入口病变  

Transoral endoscopic minimally invasive surgery for hypopharyngeal postcricoid and upper esophageal lesions

作　　者：李五一[1] 王剑[1] 杨大海[1] 霍红[1] 金晓峰[1] 牛燕燕[1] 

机构地区：[1]中国医学科学院北京协和医学院北京协和医院耳鼻咽喉科,北京100730

出　　处：《临床耳鼻咽喉头颈外科杂志》2016年第24期1913-1917,共5页Journal of Clinical Otorhinolaryngology Head And Neck Surgery

摘　　要：目的：探讨经口内镜微创手术治疗环后区和食管入口病变的疗效。方法：经口内镜微创手术治疗环后区和食管入口病变患者15例。15例中,原发于下咽环后区肿瘤类病变7例,其中浅表的环后区鳞状细胞癌3例（AJCC TNM分期：T2N0M02例,T2N2cM01例）,海绵状血管瘤2例,颈部手术切开后复发的多发纤维脂肪瘤1例,巨大纤维血管性息肉1例;食管入口区病变8例（Zenker憩室1例,脑卒中后环咽肌失弛缓引发吞咽障碍、经康复治疗失败7例）。3例环后癌均术后辅助放疗。1例T2N2cM0患者同期行双侧颈淋巴结清扫。结果：7例环后区肿瘤类病变均完整切除。3例环后癌和良性肿瘤外科切缘阴性,2例环后癌随访16～30个月和4例良性肿瘤随访2～12个月,局部无复发。近期完成手术的1例环后癌患者仍在术后放疗中。7例吞咽障碍患者4例摆脱鼻饲。1例Zenker憩室症状消失,吞咽造影复查正常。所有患者均未行气管切开术,术后第2～3天可以经口进流食或稀半流食。住院时间明显缩短,术后并发症轻微。结论：经口内镜微创手术能治疗一些环后区和食管入口病变。选择合适病例效果良好,并发症轻微,避免了传统开放手术的创伤。Objective：To describe the therapeutic effect of transoral endoscopic minimally invasive surgery for hypopharyngeal postericoidarea and upper esophageal lesions. Method： Transoral endoscopic minimally invastive surgery was carried out in fifteen patients. There were 7 patients with primary tumors on the postcricoid area, in- cluding three squamous cell carcinoma（2 cases T2 N0 M0,1 case T2 N2c M0 ）, two cavernous hemangioma, one giant fibrovascular polyp and one recurrent lipofibroma. The transoral endoscopic tumors resection en bloc was per- formed in all of them. Adjuvant postoperative radiation therapy was applied in cases of cancer, and bilateral neck dissections was performed in the T2 N2c M0 case; There were other eight patients with upper esophageal lesions , seven cases dysphagia was caused by stroke and one case was Zenker diverticulum, treated by endoscopic erieopha- ryngeal myotomy ordiverticulotomy. Result： The en bloc resection endoscopically was achieved in all of patients with tumors on the postcricoid area. All surgical resection margins were negative. The two cases of postcricoid cancer and four benign tumor were followed up 16--30 months and 2--12 months respectively, and all of the cases were not local recurrence. A recent patient with postcricoid cancer had not finished postoperative adjuvant radia- tion therapy. The endoscopic cricopharyngeal myotomy was effective in 4 out of 7 patients,nasogastric feeding was no longer required. Significant improvement occurred in Zenker diverticulotomy patient, due to the return of physi- ological deglutition, and Barium swallow study showing disappearance of the diverticulum after one month. The effects of minimally invasive threatment were satisfactory, such as not need tracheotomy and early oral feeding, shorter hospital stay and less postoperative complications. Conclusion： Transoral endoscopic surgery is minimally invastive, safe and effective treatment alternative for some hypopharyngeal postcricoid area and upper esophageal lesions.

关 键 词：外科手术 微创性 电视辅助外科手术 下咽肿瘤 吞咽障碍 ZENKER憩室 

分 类 号：R739.63[医药卫生—肿瘤]