喉黏膜瓣和胸大肌肌皮瓣修复晚期梨状窝癌术后缺损

HYPOPHARYNX RECONSTRUCTION OF DEFECTS AFTER OPERATION ON ADVANCED PYRIFORM SINUS CANCER WITH REMAINING LARYNGEAL MUCOSA FLAP AND PECTORALIS MAJOR MYOCUTANEOUS FLAP

目的 探讨对不保留喉的晚期梨状窝癌 ,采用喉黏膜瓣和胸大肌肌皮瓣修复咽部及颈段食管缺损的方法及治疗效果。 方法 1995年～ 2 0 0 1年对 12例晚期梨状窝癌患者行半喉部分咽切除术 ,其中 2例同时行颈段食管切除术 ,用喉黏膜瓣修复咽及颈段食管缺损 ;对 4例累及双侧喉部者行全喉部分咽切除术 ,用胸大肌肌皮瓣修复咽部缺损。 结果 术中无死亡。组织瓣均成活 ,仅喉黏膜瓣组 1例术前行放疗者术后发生咽漏 ;全部患者愈合后经口进普食 ,吞咽功能恢复好 ,无咽及食管良性狭窄。1例于术后 10个月死于全身广泛转移 ,另 3例分别于术后 1年死于局部肿瘤复发、颈部淋巴结肿瘤复发和肺部转移 ,其余 12例已存活 2年以上。 结论 喉黏膜瓣修复晚期梨状窝癌术后咽部及颈段食管缺损 ,手术取材及操作简便 ,创伤小 ,并发症少 ;如梨状窝癌累及双侧喉部 。

Objective To explore the outcome of hypopharynx reconstruction by using remaining laryngeal mucosa flap and pectoralis major myocutaneous flap in advanced pyriform sinus cancer. Methods Twelve patients with pyriform sinus cancers underwent hemilaryngectomy and partial pharyngectomy, two patients underwent cervical esophagectomy at the same time. The defects were reconstructed by remaining laryngeal mucosa flap. Four cases were involved in the bilateral larynx, received total laryngectomy and were repaired by pectoralis major myocutaneous flap. Results There was no operative fatal case and all flaps survived. Only one suffered from postoperative pharyngocutaneous fistulas, whose defect was reconstructed by remaining laryngeal mucosa flap and had radiotherapy. All patients could swallow ordinary food and had no benign esophagostenosis and pharyngostenosis after operation. Out of 16 pateints, 1 case died of general metastasis; 3 cases died of local tumor relapse, tumor relapse of cervical lymphonode and lung metastasis respectively within 1 year after operation; the other 12 cases survived over 2 years. Conclusion The advantage of hypopharynx reconstruction with remaining laryngeal mucosa flap is simple and convenient with less trauma and complication. The reconstruction should be completed by using the pectoralis major myocutaneous flap when the bilateral larynx are involved in.