管状成形胃一期修复下咽癌术后缺损

Use of gastric tube in primary repair of tissue defect after hypopharyngeal cancer throat violated surgery

目的探讨管状成形胃一期修复下咽癌合并喉侵犯术后缺损的临床应用。方法回顾分析2000年以来32例下咽癌合并喉侵犯患者,行喉、咽切除,食管拔脱,胃-口咽吻合手术,其中11例采用全胃重建,21例采用管状成形胃重建。结果无围手术期死亡。吻合口瘘3例,均为全胃重建术式;心律失常12例;肺部感染20例;血胸1例。后期吻合口狭窄6例,均采用内镜扩张处理。采用管状成形胃重建的患者均呼吸功能良好,无胸闷气急,6例轻度夜间反流,采用药物控制。结论胃代食管重建消化道治疗下咽癌合并喉侵犯具有良好的一期修复效果,特别是采用管状成形胃重建能有效减少术后并发症,提高患者生活质量。

Objective To explore the clinical use of gastric tube in primary repair of tissue defect after hypopharyngeal cancer throat violated surgery.Methods Thirty-two hypopharyngeal cancer patients since 2000 were studied retrospectively.They acceptted laryngopharyngectomy,esophagectomy and gastric-oropharyngeal anastomosis.Eleven of them accepted reconstruction of the entire stomach,21 of them received surgical revision using gastric tube.Results No perioperative death occurred.Twelve patients had cardiac arrhythmia,20 patients had pulmonary infection,1 had hemothorax,6 patients had minor stoma stenosis and all of them underwent endoscopic dilation.Patients receiving gastric tube revision had good respiratory function and had no chest tightness or dyspnea.Six patients had esophageal reflux and received drug control.Conclusion Reconstruction of digestive tract by gastric tube in hypopharyngeal cancer violating throat had good primary repair efficacy,especially,surgical revision by gastric tube can obviously reduce post-operative complications and improve quality of life.