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下咽及颈段食管癌的外科治疗(关于上消化道和发音功能重建的探讨) 被引量:2

Surgical treatment of hypopharyngeal and cervical esophageal cancer
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摘要 报道113例下咽及颈段食管癌患者分别应用岛状胸大肌肌皮瓣、咽胃吻合术、结肠代食管、游离空肠或前臂游离皮瓣以及残存下咽粘膜等方法重建上消化道,全组早期吞咽功能恢复率为94.6%。应用保留全喉或部分喉以及T-E分路等方法同时重建发音功能者25例,占总数的22.1%。全组1、3、5年生存率分别为79.6%、60.2%、40.7%。手术死亡2例,占全组的1.8%。作者认为所应用的上消化道重建方法是有效而可靠的,某些病例同时恢复和重建发音功能的措施也是可行的,值得临床推广。 Abstract From April 1984 to December 1996 , 113 patients with hypopharyngeal and cervical esophageal cancers were treated by different recostructive methods ,and the effects for the rehabilitation of upper alimentary and voice func- tion were evaluated. There were 92 males and 21 females , ranging in age from 23 to 73 years. Seventy of 113 pa- tients were diagnosed pyriform sinus cancer , 25 cervical esophageal cancer , 12 post wall cancer of hypopharynx and 6 postcricoid cancer. Stage Ⅲand stage Ⅳ were 83%. The pectoralis major myocutaneous flap (PMF) was used in 53 patients , total gastric transposition (GT) in 29 ,hypopharygeal mucosa (HM) in 18,colon interposition (CI) in 5, free jejunal transfer (FJT) in 4 , free forarm flap (FFF) in 3 and cervical flap (CF) in 1.Of 25 patients under- went voice rehabilitation or reconstruction (VR) , including 12 preserved total larynx , 11 partial larynx and 2 T-E shunt. One hundred and seven of 113 patients (94.6%) showed satisfactory and lasting deglutitory function were achieved. Twenty five patients showed satisfactory speaking function. One, three and five-year survival rate were 79.6 %, 60. 2% and 40. 7% respectively. These data show that the reconstructive method described above are effec- tive and reliable. My data suggest that PMF ,CT ,HM and CI are practical procedures for replacement of upper ali- mentary tract and suiatable for most clinically encountered situations. The VR is suitable for some patients of hy- popharyngeal and cervical esophageal cancer selected.
作者 李树春
出处 《中国耳鼻咽喉头颈外科》 1998年第S1期3-6,共4页 Chinese Archives of Otolaryngology-Head and Neck Surgery
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  • 1[2]Hoffman HT, Kamell LH, Shah JP, et al. Hypopharyngeal cancer patient care evaluation[J]. Laryngoscope, 1997,107:1005.
  • 2[3]Tuyns AJ. Tobacco, alcohol and diet as cancer risk factors with particular reference to cancer of the upper aerodigestive tract. In: Tobacco and cancer perspective in prevent research. Ed. Markers AP et al. Elsevir Scince Publishers. B. V. Amsterdam, 1989,133 - 136.
  • 3[4]Lippman SM,Lee JS,Lotan R,et al. Chemoprevention of upper aerodigestive tract cancer[J]. Head and Neck, 1990, 12:5 - 20.
  • 4[7]Million RR,Cassisi NJ,Mancuso AA. Hypopharynx:pharyngeal walls,pyriform sinus, postcricoid pharynx [A]. in Million RR, Cassisi NJ,Management of head and neck cancer [ C ]. 2nd ed. Philadelphia: Walswarth, 1994. 505.
  • 5刘文中,李树春,费声重,王明耀.梨状窝浅表扩展癌[J].中华耳鼻咽喉科杂志,1998,33(1):59-59. 被引量:4
  • 6李树春.岛状胸大肌肌皮瓣重建下咽和颈段食管[J].中华耳鼻咽喉科杂志,1991,26(5):299-300. 被引量:7
  • 7李树春.下咽及颈段食管癌切除后上消化道的重建[J].中华耳鼻咽喉科杂志,1992,27(3):147-149. 被引量:6

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