下咽及颈胸段食管多原发癌一期手术  

One stage surgical treatment of multiple primary carcinoma of hypopharynx and esophagus

作　　者：张炳煌[1] 骆献阳[1] 黄煦格 陈爱民[1] 姜元芹[1] 蔡成福[1] 于修义[3] 

机构地区：[1]厦门大学附属第一医院耳鼻咽喉头颈外科,福建厦门361003 [2]广州中医药大学第一临床医学院,广东广州510000 [3]厦门大学附属第一医院胸外科,福建厦门361003

出　　处：《中国耳鼻咽喉头颈外科》2017年第5期225-227,共3页Chinese Archives of Otolaryngology-Head and Neck Surgery

摘　　要：目的探讨下咽、颈胸段食管多原发癌(multiple primary carcinoma,MPC)在胸腔镜辅助下行全喉、下咽、食管切除并管状胃重建一期手术的应用及疗效。方法胸科组行胸腔镜辅助下分离食管及纵膈淋巴结清扫后开腹行管状胃成形,头颈组行颈部淋巴结清扫、全喉下咽切除、咽胃吻合术。术后常规补充放化疗。结果本组全部病例均一期完成手术,肺部感染3例,胸腔积液2例、气管撕裂1例;无吻合口瘘及围手术期死亡病例;3年生存率63.6%,5年生存率50.0%。结论下咽癌应常规行胃镜检查以免MPC的漏诊;胸腔镜辅助下全喉、下咽、食管切除并管状胃重建术可一期完成以往分次手术难以完成的手术治疗,有效提高下咽颈胸段食管多重癌的治疗效果。OBJECTIVE To discuss the therapeutic effect of one stage surgical treatment in the multiple primary hypopharyngeal and cervical thoracic esophageal carcinoma. METHODS The thoracoscopy group： dissecting the esophagus and mediastinal lymph node assisted with thoracoscope, and then opened abdominal cavity to make gastric tube. Head and neck group： doing the cervical lymph node dissection, total laryngectomy, total hypopharyngectomy and total esophagectomy, and then anastomosis of the pharynx with gastric tube. All cases were received conventional radiotherapy and chemotherapy after operation. RESULTS All the cases in this group were successfully underwent the one stage operation. The postoperative complications were pulmonary infection in 3 cases, pleural effusion in 2 cases and tracheal tear in one case. No anastomotic fistula or postoperative deaths occurred. The 3 and 5 year survival rates were 63.6% and 50.0% respectively. CONCLUSION It should take necessary examinations of cervical thoracic esophagus to prevent missing the multiple primary carcinoma of the hypopharyngeal carcinoma. The total laryngectomy, total hypopharyngectomy and total esophagectomy, and anastomosis of the pharynx with gastric tube for multiple primary hypopharyngeal and cervical thoracic esophageal carcinoma is a feasible and active treatment method.

关 键 词：下咽肿瘤 食管肿瘤 外科手术 胸腔镜检查 胃成形术 多原发癌 

分 类 号：R735.1[医药卫生—肿瘤]