结肠带蒂间置联合血管吻合在下咽癌合并食管癌手术后上消化道重建中的应用  

Colonic interposition with vascular anastomosis for upper digestive tract reconstruction after surgery for hypopharyngeal cancer with esophageal cancer

作　　者：张海林[1] 谭平清[1] 陈杰[1] 王俊琦[1] 谭浩蕾[1] 钟外生[1] 黄鹏鑫 黄文孝[1] Zhang Hailin;Tan Pingqing;Chen Jie;Wang Junqi;Tan Haolei;Zhong Waisheng;Huang Pengxin;Huang Wenxiao(Department of Head and Neck Surgery,Hunan Cancer Hospital,Changsha 410013,China)

机构地区：[1]湖南省肿瘤医院头颈外科,长沙410013

出　　处：《中华耳鼻咽喉头颈外科杂志》2024年第7期745-749,共5页Chinese Journal of Otorhinolaryngology Head and Neck Surgery

基　　金：湖南省自然科学基金(2024JJ8117);湖南省重大科技攻关计划(2023ZJ1120);湖南省肿瘤医院科研攀登计划重大专项(ZX2021002-5)。

摘　　要：目的探讨应用吻合结肠系膜血管于颈部的结肠间置手术方式对于下咽合并食管多原发癌切除后全食管、下咽重建的可行性、安全性及有效性。方法回顾性分析湖南省肿瘤医院头颈外科2019年2月至8月收治的4例同时性下咽合并食管多原发癌病例,均为男性,年龄47~58岁。患者均行全下咽、全食管切除;3例切除全喉,1例保留喉。以结肠左动脉为蒂,切取结肠平均长度约为48.5 cm,经食管床上提至颈部,挑选颈部结肠近端肠系膜血管吻合至颈部;1例与甲状腺下动脉吻合,2例与颈横动脉吻合,1例与甲状腺上动脉吻合;静脉均与颈内静脉行端侧吻合。结果4例患者术后颈腹伤口愈合良好,颈腹均未发生吻合口瘘,患者于术后21~30 d恢复经口普通饮食。随访48~52个月,2例患者因肿瘤复发死亡,2例无瘤生存。结论结肠带蒂间置联合血管吻合的重建方式安全可行,适合下咽合并食管多原发癌切除后较长距离的上消化道重建。Objective To investigate the feasibility,safety and effectiveness of colonic interposition with vascular anastomosis in reconstructing the entire esophagus and hypopharynx after resection of hypopharyngeal cancer with esophageal cancer.Methods We conducted a retrospective analysis of 4 male patients with simultaneous multiple primary cancers of the hypopharynx and esophagus,aged 47 to 58,treated in the Department of Head and Neck Surgery at the Hunan Cancer Hospital from February to August 2019.All cases underwent total hypopharyngectomy and total esophagectomy,of whom,three cases presented with total laryngectomy and one case with larynx preservation.Colonic interposition was performed using the left colic artery as a pedicle,with an average colonic length of 48.5 cm.The colon was elevated through the esophageal bed to the neck,and the branch of the colonic mesenteric artery was anastomosed to one of the neck arteries,including the inferior thyroid artery in one case,the transverse cervical artery in two cases,and the superior thyroid artery in one case,and all venous anastomoses were performed with the internal jugular veins.Results The postoperative neck and abdominal wounds healed well without anastomotic leakage,and all patients were able to resume a regular oral diet within 21-30 days postoperatively.During the follow-up of 48-52 months,two cases died due to tumor recurrence,while the remaining two cases were disease-free survivals.ConclusionColonic interposition with vascular anastomosis is a safe and reliable reconstruction method suitable for repairing long-segment upper digestive tract defects after resection of hypopharyngeal cancer with esophageal cancer.

关 键 词：下咽肿瘤 食管肿瘤 结肠间置 重建 血管吻合 

分 类 号：R735.1[医药卫生—肿瘤] R739.63[医药卫生—临床医学]