残喉气管瓣修复晚期下咽及颈段食管癌术后咽食管缺损10例分析

Repair of defect after hypopharyngo-cervical esophagectomy with laryngo-tracheal flap

目的探讨用残喉气管瓣修复晚期下咽及颈段食管癌术后咽食管缺损的手术效果。方法采用残喉气管瓣修复10例晚期下咽及颈段食管癌术后咽食管缺损,肿瘤切除后,根据咽食管缺损范围,切取合适大小的残喉气管瓣,采用后移法修复咽食管缺损。结果 10例患者1例术后出现咽瘘,1例出现咽吻合口狭窄。3例1年后复发死亡,1例2年后肺转移死亡,2例3年后颈部转移,未再继续治疗,1例失访,3例仍存活,其中1例已随访5年。结论残喉气管瓣修复晚期下咽及颈段食管癌术后咽食管缺损,效果良好,具有取材方便、不必另开辟术区、手术创伤小;缺点是必须牺牲喉功能,修复瓣的大小受限制;适用于年老体弱或有严重全身性疾病不适于保留喉功能且缺损范围不大的患者。

Objective To explore the effect of repair of defect after hypopharyngo-cervical esophagectomy with laryngo-tracheal flap. Methods Reconstruction of hypopharyngo-cervical esophagus with laryngo-tracheal flap was completed in ten patients suffering from hypopharyngeal carcinoma and cervical esophageal carcinoma. Results Pharyngeal fistula occurred in one case and pharyngeal anastomotic stenosis in another. Three cases died of recurrence one year after operation,one died of pulmonary metastasis two years after operation. Two cases had cervical lymph node metastasis three years after operation without further treatment. One was lost to follow-up. One of the three cases still alive had survived five years after operation.Conclusion With advantages of convenience,less trauma and high survival rate,good oncologic and functional results can be obtained in repair of defect after hypopharyngo-cervical esophagectomy with laryngo-tracheal flap. Due to the disadvantages of loss of laryngeal function and limitation of flap size,this repair method is unsuitable for patients with large defect.