下咽癌侵犯颈段食管的治疗

目的 探讨下咽癌侵犯颈段食管的最佳治疗方案和处理经验。 方法 通过回顾性分析71例累及颈段食管的下咽癌患者临床资料,总结几种安全有效的治疗方式。71例均行颈淋巴结清扫术,切除患侧甲状腺37例,保留喉功能28例,全喉切除气管造瘘31例,喉气管代下咽食管12例。消化道重建方法有胸大肌肌皮瓣22例、喉气管瓣修复12例、裂层皮片或生物修复膜+胸大肌肌皮瓣6例,全食管切除后胃或结肠代食管31例。术后接受局部放疗(55~70 GY)65例。 结果 术后病理均为鳞状细胞癌,其中高、中、低分化分别为21例、18例、32例。淋巴结转移率45.2%,切除甲状腺37例中病理查见肿瘤14例,占比37.8%,甲状腺受侵犯占总病例19.7%。喉功能保留占39.4%,保留喉功能的患者中拔管率67.8%,术后咽瘘12例,刀口感染2例,吻合口狭窄1例。kaplan-meier生存率统计所有病例总的3年和5年无瘤生存率为43.7%和23.9%,其中喉功能保留组分别为50%和28.6%,喉功能不保留组分别为39.5%和20.9%。两组比较差异无统计学意义(χ²=1.244,P=0.265)。 结论 下咽癌侵犯颈段食管的治疗以手术+放疗的综合治疗为主,胸大肌肌皮瓣、喉气管瓣、全食管切除胃或结肠代食管的手术方式安全有效,部分患者采用合适的手术方式可以保留喉功能。

Surgical treatment of hypopharyngeal cancer with cervical esophageal invasion

Objective To explore the best treatment plan and treatment experience of the cervical esophagus invasion of cervical esophagus.Methods From2001 to 2012,seventy-one patients with advanced hypopharyngeal cancer and cer-vical esophageal invasion were retrospectively reviewed to summarize several safe and effective treatment methods,in-cluding 64 males and 7 females.The medianage was 56.8 years old,ranged from 36 to77 years old.According to AJCC 2002 criteria,all the tumors were T4 stage and originated from the pyriform sinus(51),posterior pharyngeal wall(18), post cricoid area(2),there were 44 patient sincN0,4 in cN1,20 in cN2,3 in cN3 and no distant metastasis.Precise preoperative evaluation was performed with computed tomography scan,barium swallow perspective and biopsy.All the patients received neck dissection,including both unilateral(57 patients)and bilateral(14 patients).Pharyngoesophageal defect reconstruction methods were:pectoralis major musculocutaneous flap in 22 patients,laryngotracheal flap in 11, pectoralis major musculocutaneous flap combined with split thickness skin graft in 6,stomach pulling-up or coloninter-positionin in 31 patients.Total laryngectomy was carried out in 31 patients.65 patients received radio therapy postopera-tively(dose55-70 Gy).Results The cervical lymph node metastasis rate was 45 .1%.In 28 patients whose laryngeal function was preserved,the trachea cannula was extracted in 19 patients,with the decanulation rate as 67.8%.A total of 37 patients underwent thyroidectomy,14 cases of postoperative patients with pathologically confirmed thyroid invasion.The common complications after surgery with pharyngeal fistula in 12 cases,2 cases of incision infection, anastomotic stenosis in 1 cases.The 3 years and 5 years disease-free survival rate in all patients were 43.7%and 23.9% which calculated by Kaplan-Meier methods.The 3 years and 5 years disease-free survival rate of laryngeal function preservation group were 50% and 28.6%,while in non-functionally preserved group were 39.5% and 20.9%. There was no significantly different between the two groups(χ2 =1.244,P =0.265).Conclusion Combined therapy was the best choice for hypopharyngeal cancer with cervical esophageal invasion.The continuity of the pharyngoesopha-gus was restored by laryngotracheal flap,pectoralis major muculocutaneous flap or with split thickness skin graft.Stom-ach trans-position or colon interposition was used while the defect of the esophagus was greater.All of those operation methods were safe and effective.Some patients with appropriate surgical procedures can retain the patients laryngeal function.