摘要
目的分析喉咽及颈段食管癌病变切除后上消化道重建的合理性。方法回顾性分析2009年5月至2015年4月本院收治的54例喉咽及颈段食管癌患者,其中有11例女性,43例男性。在48例咽喉癌中包括环后癌3例、35例梨状窝癌、咽喉后壁癌5例,5例为颈段食管癌。AJCC癌症分期:3例I期、9例II期、20例III期(包括1例T1N1M0、2例T2N1M0、6例T3N0M0、11例T3N1M0)、19例IV期(包括1例T1N2M0、2例T2N2M0、7例T3N2M0、2例T3N3M0、3例T4N0M0、1例T4N1M0、3例T4N2M0),所有患者均经手术治疗。结果 66.66%(36/54)的患者行带蒂胸大肌肌皮瓣术,12.96%(7/54)的患者为胃上提代食管术,3.70%(2/54)的患者为游离组织瓣术、1.85%(1/54)的患者为游离空肠代食管术,1.85%(1/154)为结肠上徒代食管术,3.70%(2/54)的患者为复合瓣术,3.70%(2/154)的患者为喉咽黏膜术,5.55%(3/54)的患者为喉气管瓣术。重建早期吞咽成功率为96.29%(52/54),术后有14.81%(8/54)的患者并发咽-皮肤瘘,占到3.70%(2/54)的患者出现移植物全部或部分脱落,共有16.66%(9/154)的患者恢复或重建发音功能,5.55%(3/54)的患者患者已拔出导管,术后1个月内有1.85%(1/54)的患者死亡。结论喉咽及颈段食管癌病变切除后上消化道重建属于可靠、有效的方法,应从患者实际情况出发,做出具有针对性的选择应用,若患者属于胸上段食管癌可选取食管内翻拔脱切除,上提胃予以颈段食管胃吻合术进行治疗,相对于肌皮瓣,在喉咽及喉部分切除术中使用游离组织瓣重建的效果更为显著,这样才能保证术后患者维持相对正常的消化功能,便于患者生存。
Objective Analysis the upper digestive tract reconstruction is reasonable after resection of hypopharyngeal and cervical esophageal cancer. Methods 54 hypopharyngeal and cervical esophageal cancer patients were retrospectively analyzed from May 2009 to April 2015 in our hospital from, including 11 female,43 male. In 48 patients with hypopharyngeal cancer included 3 postcricoid carcinoma,35 pyriform sinus carcinoma,5 posterior wall of pharynx carcinoma;5 cervical esophageal carcinoma. According to AJCC,3 cases of stage I,9 cases of stage II,20 cases of stage III（including 1 case of T1N1M0,2 T2N1M0,6 T3N0M0,11 T3N1M0）nineteen IV（including 1 case of T1N2M0,2 T2N2M0,7 T3N2M0,2 T3N3M0,3 T4N0M0,1 T4N1M0,3 T4N2M0）,all patients were treated by surgical treatment. Results 66.66%（36/54）patients were performed pedicled pectoralis major muscle flap,12.96%（7/54）patients with gastric pull-up esophageal reconstruction,3.70%（2/54）patients for free flap surgery,1.85%（1/54）with free jejunal interposition,1.85%（1/54）for colon and generation feed tube surgery,3.70%（2/54）of the patients with composite flap,3.70%（2/54）in patients with hypopharyngeal mucosa and 5.55%（3/54）in patients with laryngotracheal flap reconstruction. The success rate of early swallowing was 96.29%（52/54）,postoperative14.81%（8/54）of the patients with skin pharyngeal fistula. Accounted for 3.70%（2/54）patients showed off all or part of the graft,a total of 16.66%（9/54）patients to restore or reconstruct the pronunciation function,5.55%（3/54）patients who have pulled out the catheter within 1 months after operation in 1.85%（1/54）of the patients died. Conclusion Hypopharyngeal and cervical esophageal carcinoma resection after digestive tract reconstruction is reliable,effective method,patients from the actual situation of making for the selection and application,if the patient belongs to the upper thoracic esophageal carcinoma can be selected transhiatal esophagectomy resection,lifting the stomach be cervical food tube anastomosis were treated,with respect to the muscle flap in the hypopharynx and larynx resection intraoperative use of free tissue flap in the reconstruction of the effect is more significant,In this way can we guarantee the postoperative patients remain relatively normal digestive functions,easy to survival.
出处
《中国医学文摘（耳鼻咽喉科学）》
2016年第4期181-184,共4页
Chinese Medical Digest(Otorhinolaryngology)
关键词
喉咽
颈部
食管癌
上消化道
Hypopharyngeal
Cervical
Esophageal Carcinoma
Upper Digestive Tract
