游离空肠移植重建下咽及颈段食管112例临床分析

Reconstruction of hypopharyngeal circumferential and cervical esophageal defects with free jejunal interposition in 112 cases

目的探讨游离空肠修复下咽及颈段食管肿瘤切除术后组织缺损的方法及疗效。方法回顾性分析1984年10月至2009年10月中国医学科学院肿瘤医院头颈外科112例下咽、颈段食管癌及喉癌复发患者肿瘤切除术后所致下咽环周及颈段食管缺损以游离空肠进行I期修复的临床资料。结果112例患者中，游离空肠坏死6例，游离空肠移植成功率94．6％（106／112）；吻合口瘘发生率、吻合口狭窄率分别为8．9％（10／112）、12．5％（12／96）；围手术期死亡率1．8％（2／112）。除1例围手术期死亡、6例空肠坏死和2例保留喉患者未恢复经口进食外，其余103例患者在术后平均12d恢复经口进食。结论游离空肠移植手术成功率高，手术并发症及围手术期死亡率低，吞咽功能恢复快。对颈动脉未受侵，能保证手术安全切缘的患者，建议首选游离空肠修复。

Objective To investigate the results of reconstruction of hypopharyngeal circumferential and cervical esophageal defects with free jejunal transfer. Methods Retrosepeetive review of 112 patients who underwent pharyngoesophageal reconstruction with free jejunal interposition. Analysis was confined to the patients with advanced hypopharyngeal, esophageal or recurrent laryngeal squamous cell cancer. Kaplan- Meier method was used to identify the accumulative survival rate. Results The free jejunal success rate was 94.6% （106/112）. The pharyngocutaneous fistula rate and anastomoses narrow rate were 8.9% （10/112 ） and 12. 5% （12/96） respectively. The perioperative mortality rate was 1.8% （2/112）. Except 1 case of dead, 6 cases with flap failure and 2 cases with laryngeal preservation, other 103 cases had resumed oral feeding. Conclusions The success rate of free jejunal transplation is high and free jejunal interposition is an ideal reconstruction method for patients who have hypopharyngeal circumferential and cervical esophageal defects after tumor resection.