晚期下咽癌和颈段食管癌的外科治疗体会

Surgical thcrapy for advanced stage hypopharyngeal cancer and cervical esophageal carcinoma

目的对晚期下咽癌和颈段食管癌大面积切除后的组织缺损,应用胃(肠)咽吻合术重建恢复功能经验及疗效总结。方法对35例胃(肠)咽吻合术的临床资料进行了回顾性分析,胃上提18例,带蒂结肠17例,其中保留迷走神经干14例。结果34例获得良好的吞咽功能。无胃肠坏死等严重并发症。颈淋巴结转移率62.9%(22/35),3年生存率54.3%(19/35),5年生存率39.3%(11/28),最长1例已存活10年。结论胃(肠)咽吻合术对晚期下咽癌和颈段食管癌切除后大范围下咽-食管缺损具有较好的I期效果。颈淋巴结清扫术是外科治疗重要的一部分。术中注意局部解剖结构,精细操作,可减少并发症,提高生活质量。

Objective To review the reconstruction surgery of the defect after en bloc removal of advanced stage hypopharyngeal cancer and esophageal carcinoma of cervical segment by gastric-pharyngeal anastomosis or colon-pharyngeal anastomosis. Methods The clinical data of 35 cases accepted gastric-pharyngeal anastomosis （ 18 cases） or colon-pharyngeal anastomosis （ 17 cases） were analysed, retrospectively, in which vagus nerves of 14 cases were remained. Results Thirty four cases had good function of deglutition after operation. There was no severe complication such as necrosis of stomach or intestine. Cervical metastasis rate was 62. 9% （ 22/35 ）. Three-year and five-year survival rate were 54. 3% （ 19/35 ） and 39. 3% （ 11/28 ） , respectively. One of the 35 cases have survived for ten years. Conclusion Gastric-pharyngeal anastomosis or colon-pharyngeal anastomosis can result in good outcome in treatment of the defect after en bloc removal of advanced stage hypopharyngeal cancer and esophageal carcinoma of cervical segment. Cervical dissection is an important portion of surgical therapy. Paying attention to the local anatomic structures and careful operation during surgical procedure can decrease the occurrence of complication and increase the quality of life.