游离皮瓣及游离空肠修复下咽及颈段食管缺损的对比分析

Comparing the free fasciocutaneous flap with free jejunium in reconstruction for hypopharyngeal and cervical esophageal defects

目的:探讨游离皮瓣与游离空肠在下咽癌及晚期喉癌切除术后下咽及颈段食管缺损修复中的应用,比较两种组织瓣在下咽及颈段食管缺损修复中的优劣。方法:对2000-2010年采用游离皮瓣(32例)和游离空肠(24例)修复下咽及食管缺损的56例患者作回顾性研究,比较二者的适应证、并发症、住院时间、吞咽功能的恢复情况及术后生存时间。结果:游离皮瓣组和游离空肠组的3年生存率分别为59.3%、55.7%,5年生存率分别为38.5%、37.1%;术后总并发症发生率分别为18.8%、16.7%,游离皮瓣组较游离空肠组有较高的咽瘘及供区瘢痕形成,而游离空肠组较游离皮瓣组有较高的肠梗阻及吻合口狭窄的发生率;2组平均住院天数分别为(15.00±7.06)d、(13.00±6.75)d;全部患者术后均可经口进食,平均术后进食时间分别为(13.00±5.83)d、(11.00±6.67)d。2组之间的上述观察指标差异均无统计学意义(P>0.05)。结论:血管化游离皮瓣和游离空肠是修复下咽食管环形缺损最常用的两种方法,有其各自的优缺点。临床应根据下咽食管缺损的部位和范围、术前及术后放疗需求来选择合适的修复方法。

Objective：To investigate the application of the reconstruction methods for hypopharyngeal and cervical esophageal defects due to the resection of hypopharyngeal cancer and advanced laryngeal cancer between free fasciocutaneous flaps and free jejunium transfer.We compared the superiorities and inferiorities of these two reconstruction methods.Method：Retrospective review of the archives of 56 patients from 2000 to 2010who underwent pharyngoesophageal reconstruction with free flaps（n=32）or free jejunal transfer（n=24）,comparison of indications,complications,hospitalization duration,swallowing function recovery and postoperative survival time.Result：The overall 3year survival rate of free flap group and free jejunal transfer group was 59.3%,55.7% respectively;the overall 5year survival rate was 38.5%,37.1%respectively.The overall rate of complication rate was 18.8%,16.7% respectively.The patients with free flaps had higher incidence rate of fistula and scarring in the donor site and lower incidence rate of hues and stricture than the ones with free jejunal transfers.The mean hospitalization duration was（15.00±7.06）days and（13.00±6.75）days.The mean time of first oral food intake was（13.00±5.83）days and（11.00±6.67）days.The differences between two groups had no statistical significance（P〉0.05）.Conclusion：Free flaps and free jejunium transfer are the two most common reconstruction methods for the hypopharyngeal and cervical esophageal defects.Each has its own advantages and disadvantages respectively.We should choose reconstruction method according to the site and extent of the hypopharyngeal and cervical esophageal defects,preoperative and postoperative radiotherapy requirement.