喉气管瓣法重建下咽颈段食管治疗梨状窝环后癌13例

Laryngotracheal flap reconstruction of hypopharyngoesophagus in pyriform-postcricoid carcinoma resection

目的 探讨梨状窝环后癌切除后重建下咽颈段食管的改进术式和术后效果。方法 1990年 1月～2 0 0 1年 12月手术治疗晚期梨状窝环后癌患者 13例 ,行一侧下咽梨状窝切除 +半喉或喉大部切除 +食管入口或颈上段食管切除。肿瘤切除后用喉气管瓣整复下咽和颈段食管 ,其中 7例采用喉气管瓣后移法 ,6例采用改进术式气管瓣翻转法。全部病例均行术后放疗。结果 喉气管瓣后移法 7例中 ,5例创口Ⅰ期愈合 ,2例切口感染形成咽漏 ;气管瓣翻转法 6例中 ,5例创口Ⅰ期愈合 ,1例切口感染形成咽漏 ;以上 3例咽漏均经换药愈合。两组各有 1例术后放疗后食管吻合口部位发生狭窄 ,但可进食浓流质饮食。术后 5年随访 ,共有 7例无瘤生存 ,进食半流质软质饮食通畅 ,全身状况好 ;5例死亡 ;1例失随访。结论 喉气管瓣后移和气管瓣翻转两种方法重建梨状窝环后癌切除导致的下咽与颈段食管缺损 ,均取得良好效果。改进术式气管瓣翻转修复方法能在喉瓣面积过小时有效整复食管入口和下咽部分缺损 ,是肿瘤切除后下咽食管入口缺损较理想的修复方法。

Objective A retrospective study to review the modified surgical approach and its outcome in reconstruction of hypopharyngoesophagus after pyriform-postcricoid carcinoma resection.Methods Thirteen cases with advanced pyriform-postcricoid carcinoma,mostly involving pyriform apex and cevical esophagus,were treated by radical procedure of surgery between January 1990 and December 2001.Reconstruction of hypopharyngoesophagus was completed in seven cases with the classical method of laryngotracheal flap,and six cases,who suffered extensive involving of larynx that produced too small laryngeal flap,used a modified procedure-tracheal flap on headstand combined with the lingual flap.Results Pharyngocutaneous fistula was noted in two cases in the group of classical method,and one case in the group of modified procedure.The fistula of all the three cases healed by dressing change.Pharyngoesophageal stenosis occurred in one case in each group after radiotherapy.There were seven cases in total servival over 5 years with disease-free.Conclusion Good oncologic and functional results were achieved in the two groups of patients.The modified procedure of tracheal flap combined with the lingual flap is an effective method for reconstruction of hypopharyngoesophagus after pyriform-postcricoid carcinoma resection.