晚期喉咽癌侵犯颈段食管的围手术期处理

The perioperative treatment of hypopharyngeal carcinoma with cervical esophageal invasion

目的 :探讨晚期喉咽癌侵犯颈段食管患者的围手术期处理方法。方法 :侵犯颈段食管的 7例喉咽癌患者中 ,6例行一侧功能性颈廓清 ,喉下咽全切除 ,颈段食管剥脱 ,胃上徙 ,胃咽吻合术 ;1例行一侧根治性颈廓清 ,喉下咽全切除 ,颈段食管剥脱 ,胃大部切除 ,结肠上徙 ,结肠残胃、结肠咽吻合术。术中 5例切除一侧甲状腺。结果 :术后并发胃咽吻合口瘘 1例 ,急性肾功能衰竭 1例 ,所有患者均有不同程度的呕吐及其他消化功能不适 ,经治疗顺利度过围手术期。结论 :加强晚期喉咽癌侵犯颈段食管患者的围手术期处理 ,可使患者顺利接受术后放疗等综合治疗 ,提高肿瘤的治愈率和患者的生存率。

Objective:To present our experiences of perioperative therapy on 7 patients suffered from hypopharyngeal carcinoma with cervical esophageal invasion.Method:Among the 7 patients,6 patients had unilateral functional neck dissection, total laryngoesophagectomy and reconstruction with gastric pulling-up.One patient had gastrectomy, reconstruction with colonic pulling-up as well as radical neck dissection, total laryngoesophagectomy.Five of 7 patients have unilateral partial thyroidectomy.Result:All patients complained of vomiting and other abnomalities of digestion, 1 case complicated with pharyngocutaneous fistula, 1 patient developed acute renal failure, postoperatively.Conclusion:It is very important to improve theraputic skill during perioperative period,which can reduce complications of advanced hypopharyngeal and cervical esophageal cancer and increase patients' survival.