用硅橡胶管重建下咽及颈段食管缺损

Reconstruction with silicone rubber tube after resection of hypopharyngeal and cervical esophageal cancer

目的重建下咽及颈段食管癌切除后缺损和治疗该部位的疤痕性狭窄和咽瘘。方法采用自行研制的医用硅橡胶管进行重建。在动物实验和１例患者病理学检查中，可见术后缺损处肉芽表面上皮化，形成新的管腔。结果应用于下咽及颈段食管癌２５例，良性狭窄及咽瘘修补５例中，术后并发咽瘘６例（２０．０％）。随访５个月～４年（平均２．５年），已拔除硅橡胶管２５例，恢复吞咽功能及正常饮食２３例，再度发生狭窄２例；现带管观察２例。癌肿２５例中，术后３～６个月局部癌复发２例，颈淋巴结癌转移复发４例，该６例均在术后１年内死亡。另死于肺转移１例，因肺炎死亡２例。癌肿患者术后３年生存率５０．０％（５／１０）。结论下咽及颈段食管缺损１０ｃｍ以内者，此法效果满意。

Objective To treat the benign stenosis and defects caused by resection of cancers of hypopharyngeal and cervical esophagus. Methods Silicone rubber tubes made by ourselves were utilized to reconstruct the defect It was found that in animal models, the granulation surface was covered with epithelial tissues and new lumen formed. Results Among 30 cases treated with silicone rubber tubes,6 cases (20.0%) developed hypopharyngeal fistulae after operations.Twenty five cases with cancer and 5 cases with benign stenoses and hypopharyngeal fistulae were followed up from 5 months to 4 years.The silicone rubber tubes in 25 cases were decannulated, of them, 23 cases recovered normal swallowing function. Two cases developed severe stenosis again and 2 cases were under observation. In 25 cases with cancer, 2 had local relapse of cancer three to six months after the first operation. Four cases had cervical metastasis. All these 6 cases died within one year after operation. One case died of lung metastasis, two cases died of inflammation of lungs. Among 25 patients with cancers, the three year survival rate was 50. 0 % ( 5/10) . Conclusion For defects in hypopharynx and cervical esophagus less than 10cm, silicone rubber tube reconstruction is satisfactory.