游离空肠移植重建咽和颈段食管治疗晚期下咽癌11例报告

Free Jejunal Grafts for Reconstruction of Pharynx and Cervical Esophasgus

为了解决晚期下咽癌广泛切除后咽和颈段食管重建问题，我们采用小血管吻合技术，用自身的游离空肠移植重建咽和颈段食管，共完成１１例，吻合血管均成功。手术一期完成，并发症少，本组仅咽瘘２例，吻合口出血１例，术后半月经口进食，吞咽功能恢复好，手术三年成活率为３６％，死亡的主要原因是颈部淋巴结转移、复发。我们认为此法手术成功率高，安全可靠，对患者损伤比胃咽吻合术小，只要通过小血管吻合技术的训练，是可以选择此术式的。

Eleven patients with hypopharyngeal carcinoma were treated surgically and the pharynx and cervical esophagus were reconstructed with free jejunal grafts through the technique of microvascular anastomosis.The microvascular anastomosis were all successful and the patients all survived the operations.The operations were performed at one time with only a few complications.There were 2 cases of pharyngeal fistula and 1 case of bleeding from the anastomotic site.The patients could eat by their mouths and swallow very well just 15 days after the operation.The 3year suvival rate was 36%.The main causes of death were the recurrence and the metastasis to the cervical lymph nodes.We came to the conclusion that the operation is safe with high success rate and no mortality during operation,and it is less injurious than the gastropharyngeal anastomosis .The key point of the operation is the surgeon's mastery of the microvascular anastomosis technique.