非开胸胃代食管术治疗同时性下咽并胸段食管重复癌5例

Substituting the esophagus with the stomach without thoracotomy in the treatment of hypopharynx and thoracic segment esophagus synchronous multiple primary carcinoma:a clinical analysis of 5 cases

目的探讨非开胸胃代食管术治疗同时性下咽并胸段食管重复癌的方法和疗效。方法对5例同时性下咽并胸段食管重复癌患者,均行非开胸食管内翻拔脱胃上徙术。喉功能保留3例,其中1例下咽后壁癌患者因胃上徙高度不够,采用前臂桡侧游离皮瓣修复下咽及颈段食管;全喉切除2例。结果5例吞咽功能全部恢复,无吞咽困难发生。1例发生咽瘘,经保守治疗痊愈。3例保留喉者均有不同程度呛咳症状。3例保留喉功能者术后全部拔管,发音质量良好。随访1～4年,1年生存率100%（5/5）,3年生存率60%（3/5）。结论提高对同时性下咽并胸段食管重复癌的认识,采用非开胸胃代食管术治疗,优越性为成功率高、并发症较少,是一个较理想的手术方法。

Objective To study the feasibility and effect of substituting the esophagus with the stomach without thoracotomy in the treatment of hypopharynx and thoracic segment esophagus synchronous multiple primary carcinoma. Methods Five patients with hypopharynx and thoracic segment esophagus synchronous multiple primary carcinoma who had undergone esophageal stripping without ＇thoracotomy and gastropharyngostomy were retrospectively studied. The larynx remained in 3 cases and total laryngectomy was performed on 2 cases. Results The function of deglutition was good in the 5 cases. Pharyngeal fistula occurred in 1 case and was cured by conservation treatment.The laryngeal function preservative rate was 60.0% （3/5） and the decarnnulation rate was 100% （3/3）. Followed up from 1 to 4 years, 1-year survival rate was 100% （5/5） and 3-year survival rate was 60% （3/ 5）. Conclusion Substituting the esophagus with the stomach without thoracotomy might improve both local control and survival in the treatment of hypopharynx and thoracic segment esophagus synchronous multiple primary carcinoma.