颈阔肌皮瓣重建下咽癌切除后颈段食管缺损

Reconstruction of circumferential defect of cervical esophagus with platysma myocutaneous flaps after resection of hypopharyngeal carcinoma

目的解决下咽癌浸及颈段食管手术后食管缺损的修补。方法采用双侧颈阔肌肌皮瓣重建下咽癌切除后颈段食管缺损１１例。肿瘤均已侵及喉和颈段食管，行全咽、全喉及颈段食管切除，永久性气管造口，于颈部两侧分别切取３．５～４ｃｍ×７～１０ｃｍ大小的颈阔肌肌皮瓣，形成管状，与口底及食管吻合。结果术后肌皮瓣全部成活，无１例死亡，２例发生瘘，均治愈，能正常经口进食。结论用颈阔肌肌皮瓣修补下咽癌切除后造成的食管缺损是一个可取的方法，解决了临床一大难题。

Objective To show the results of reconstruction of circumferential defect of cervical esophagus with platysma myocutaneous flaps after resection of hypopharyngeal carcinoma in 11 cases.Methods Total larynx,pharynx and cervical esophagus were resected and a permanent tracheostomy was made in the patients, because the cancer had invaded the larynx and cervical esophagus. Two platysma myocutaneous flaps were designed and dissected at both anteror lateral neck, which was about 3 5￣4cm×7￣10cm respectively.The flaps were made into a skin tube.The upper edge of the skin tube was sutured to the cut end of the pharynx and the lower sutured to the end of the esophagus.Results All of the flaps survived and there was no death after operation. There was fistula in 2 cases. The fistula healed after 14 days and 18 days respectively.All cases were normal in swallowing food.Conclusions The operative methods,advantages and experiences are also descussed.