颈段食管重建术中喉返神经的保护

The protective measures for recurrent laryngeal nerve in cervical esophageal reconstruction

目的 探讨颈段食管重建手术中喉返神经的保护措施。方法 对1983～2005年完成的31例颈段食管重建手术的病人资料进行回顾性分析，其中颈段食管癌23例，严重下咽食管狭窄8例，术前均无声音嘶哑。根据病情采用不同的手术术式，其中不开胸食管拔脱胃上提17例，结肠上徙10例，空肠移植4例。结果 所有病人恢复吞咽功能，平均恢复经口进食时间为22．1d。气管切开病人均拔除气管套管，平均拔管时间为45．3d。术后声嘶11例，饮食呛咳7例，肺部感染5例，咽瘘3例，吻合口狭窄、吻合口瘘、腹部伤口裂开各1例。结论 颈段食管重建手术中采取必要措施可有效减少喉返神经损伤，提高病人生活质量。

Objective To investigate the protective measures for recurrent laryngeal nerve in cervical esophageal reconstruction. Methods Clinical data of 31 patients who underwent cervical esophageal reconstruction without preoperative hoarseness from 1983 to 2005 were analyzed retrospectively. The patients included 23 cases of cervical esophageal carcinoma and 8 cases of severe pharyngoesophageal stenosis. The treatment was selected according to the patients＇ state of illness. Esophagectomy without thoracotomy was carried out in all cases. Reconstruction of the esophagus consisted of 17 stomach pulling-up, 10 colon interposition, and 4 free jejunal graft. Results All patients succeeded in the deglutitory function and decannulation. The average course for rehabilitation of normal devouring function was 22.1days and that from operation to decannulation was 45.3 days. Complications included hoarseness, bucking, pulmonary infection, pharyngeal fistulas, cervical stomal fistulae, cervical stomal stenosis and splitting of abdominal wall. Conclusion The essential measures in cervical esophageal reconstruction can decrease nerval injure and elevate quality of life.