保留喉功能的下咽癌手术后缺损的修复

目的初步探讨在保留喉功能的下咽癌手术中，肿瘤切除后局部创面的修复方式。方法回顾性分析2013年3月~2018年3月33例下咽癌患者行保留喉功能肿瘤切除术后的临床资料，其中14例采用局部黏膜拉拢缝合，2例采用胸骨舌骨肌筋膜瓣修复缺损，4例采用异种牛脱细胞真皮基质修复膜，2例采用胸大肌皮瓣修复，4例锁骨上岛状皮瓣修复缺损，4例采用游离股前外侧皮瓣修复缺损，3例采用食管内翻拔脱胃上徙手术；观察缺损修复后患者伤口的愈合情况。结果33例患者喉功能良好，3例患者早期有轻微误吸，锻炼2周后即可正常进食。全部患者恢复吞咽功能，食管入口狭窄2例，后经局部扩张好转。咽瘘2例，局部换药1个月愈合。所有患者术后随访1年以上，生存率为78.79%（26/33），目前正在随访中。结论在保留喉功能的下咽癌手术中，防止误吸和避免咽食管狭窄是肿瘤切除后修复的主要目标；根据患者的具体情况，选择适合患者的个体化修复方法，既可以恢复下咽的结构和功能，还可以避免不必要的副损伤。

Repair of defect after operation with preservation of laryngeal function in hypopharyngeal carcinoma

ObjectiveTo investigate the repair method of local defect after tumor resection with laryngeal function preservation in hypopharyngeal carcinoma.MethodsClinical data of 33 patients receiving defect repair after tumor resection with laryngeal function preservation in hypopharyngeal carcinoma in our department from March 2013 to Dec 2018 were analyzed retrospectively.Of them, the defects were closed by direct mucosal suture in 14 cases, repaired with sternohyoid fascial flap in 2, heterologous bovine acellular dermal matrix membrane in 4, pectoralis major myocutaneous flap in 2, supraclavicular island flap in 4, free anterolateral thigh flaps in 4 and esophageal uplift and gastric migration in 3. All the patients were followed up to evaluate their wound healing.ResultsAll the 33 patients had good laryngeal function, and 3 had mild aspiration in the early stage and got normal feeding after two week exercise. Swallowing function got recovered in all cases with 2 of esophageal entrance stenosis improved with local expansion, and 2 of pharyngeal fistula healed by one month local dressing. All the patients had been followed up for more than one year with a one year survival rate of 78.79% (26/33), and the survivors are under follow up.ConclusionsIn the postoperative defect repair of hypopharyngeal carcinoma with laryngeal function preservation, prevention of aspiration and avoidance of pharyngosterosis and esophagostenosis are the main targets. Individualized repair method based on the the patient condition is capable of restoring the structure and function of hypopharynx while avoiding unnecessary secondary damage.