颈阔肌皮瓣在颈段食管狭窄重建术中的应用

Application of platysma myocutaneous flaps reconstructing esophagus in stenosis of cervical esophagus

目的 :探讨颈阔肌皮瓣在颈段食管狭窄重建术中的应用。方法 :采用单侧颈阔肌皮瓣行颈段食管狭窄重建术 33例。结果 :术后肌皮瓣全部存活。 3例发生吻合口瘘 ,加强更换敷料后愈合。术后随访 6～ 15 6个月 ,2例分别于术后 4和 6个月发生吻合口狭窄 ,分别经食管扩张和食管成形术治愈。所有患者均能经口进普食。纤维食管镜检查示肌皮瓣无糜烂及溃疡。结论 :颈阔肌皮瓣行颈段食管狭窄重建 ,具有创伤小 ,取材方便 ,操作简单 ,能Ⅰ期完成手术 ,并发症少 ,远期疗效满意等优点。

Objective:To observe the application of platysma myocutaneous flaps (PMF)reconstructing esophagus in stenosis of cervical esophagus.Method:Retrospeetire analysis was carried out in 33 patients with stenosis of the cervical esophagus reconstructed by PMFs in our department from April 1990 to January 2003. The patients were followed up for 6 to 156 months with esophagography and esophagoscopy. The pathological changes of the flaps were examined with biopsy in 4 cases.Result:There was no operative death. All the flaps survived. Three patients developed fistula of cervical anastomosis after operation and healed with conservative method. Stricture of cervical anastomosis occurred in 2 cases, one patient received diatation and one treated by reoperation.The transferred flaps had no ulcer and cancer in long time follow up. The squmaous epitllelial lawyer of the skin is thinner, but keep keratinization. All the patients were able to take solid foods.Conclusion:The advantages of repairing stricture of cervical esopllagus with PMF is that the operative wound is small, the transference is easy and can be completed in one stage, the postoperative complication is low, the long term result is excellent. The PMF is one of good option for cervical esophageal reconstruction.