喉癌下咽癌患者下咽及颈段食管术后缺损的修复方法

目的 :探讨喉癌下咽癌患者下咽或下咽及颈段食管术后缺损的修复方法。方法 :对保留喉功能的下咽术后缺损 9例 (伴颈段食管部分切除 3例 ,颈段食管癌行食管全切除 1例 ) ,用胸大肌肌皮瓣修复 4例 ,直接修复 4例 ,胃咽吻合术 1例。不保留喉功能 2 0例 (伴颈段食管部分切除 2例 ) ,舌瓣修复 16例 ,喉组织瓣 2例 ,胸大肌肌皮瓣与胸骨舌骨肌筋膜瓣联合重建下咽 2例。结果 :术后 8例Ⅰ期恢复吞咽及喉功能 ,1例下咽狭窄 ,Ⅱ期行残喉切除。余 2 0例中 16例Ⅰ期恢复吞咽功能 ,1例下咽狭窄经扩张进食 ,3例咽瘘 ,其中 1例咽瘘行Ⅱ期胃咽吻合术。 1、3及 5年的生存率分别为 92 %、6 4 .7%和 4 6 .2 %。结论 :保留喉功能的下咽或下咽及颈段食管缺损可直接修复或采用胸大肌皮瓣修复 ,不保留喉功能者 ,可采用舌瓣、胸大肌皮瓣修复或咽胃吻合术。肌皮瓣和肌筋膜瓣联合重建全下咽易引起下咽狭窄或咽瘘

Hypopharyngeal and cervical esophageal repairing

OBJECTIVE: To explore the ways of repairing the hypopharyngeal and cervial esophageal breach postoperatively. METHOD: 6 kinds of operations in 29 patients with hypopharyngeal and cervical esophageal repairing were analyzed. RESULT: In 9 patients laryngeal function reserved, 8 cases recovered their function of swallow and speech postoperatively. One received a laryngectomy in II stage for wrong swallow. In 20 cases without laryngeal function, 17 cases can swallow, but 3 cases had fistula. The 1, 3 and 5 year survival rates were 92%, 64.7% and 46.2% respectively. CONCLUSION: The firsthand suture and pectoralis major myocutaneous flap were better for the hypopharyngeal repairing of the patients with laryngeal function. The glossus flap, laryngeal tissue flap, pectoralis major myocutaneous flap and gastric-pharyngeal tally are useful for the digestive canal reconstruction of the patients with laryngectomy.