下咽颈段食管癌行游离空肠移植重建103例临床分析

Reconstruction with free jejuna flap for the defect after removal of hypopharyngeal and cervical esophageal caneer： clinical analyses of 103 cases

目的 探讨下咽颈段食管癌环周切除行游离空肠移植修复的围手术期处理经验及疗效观察.方法 回顾性分析2008年8月至2015年3月山东省立医院耳鼻咽喉科103例下咽颈段食管癌环周切除行游离空肠移植修复的临床资料.其中下咽癌84例,颈段食管癌19例;行保留喉的颈段食管切除术2例,全喉全下咽切除31例,全喉全下咽颈段食管切除70例;均行双侧颈淋巴清扫术,84例行咽后淋巴清扫.结果 3年总生存率和3年无瘤生存率分别为51.6％和50.0％,5年总生存率39.1％.无围手术期死亡病例,空肠术后坏死1例,二次取空肠移植修复成功,空肠移植总成活率99％.术后咽瘘3例,均换药后愈合.所有患者均恢复经口进食,无吻合口狭窄发生.结论 游离空肠移植修复下咽颈段食管环周缺损疗效肯定,多学科合作可显著提高游离空肠移植的成功率,可作为下咽颈段食管癌行环周切除后的首选修复方法.

Objective To report our experience in reconstruction with free jejunal flap for circumferential defect following resection of hypopharygeal and cervical esophageal carcinoma.Methods A retrospective analysis was conducted to evaluate the outcomes of reconstruction with free jejunal flaps for circumferential defects in 103 patients treated from Aug 2008 to Mar 2015.Among them,84 were hypopharyngeal carcinoma and 19 were cervical esophageal carcinoma;31 patients had total pharyngolaryngectomy,70 had total pharyngolaryngectomy and cervical esophagectomy and 2 had laryngeal preservation.All patients underwent bilateral neck dissection and 84 underwent retropharyngeal lymph node dissection.Results The 3 year overall survival rate was 51.6% and disease-specific survival rate was 50% The 5 year overall survival rate was 39.1%.No in-hospital death,one patient had unsalvageable flap failure and underwent second reconstruction with free jejunal flap.The success rate for the free jejunal flaps was 99% （102/103）.Pharyngocutanous fistula occurred in 3 patients and all healed with conservative treatment.Satisfactory oral intake was achieved in all patients.Conclusions Oncological and functional outcomes of reconstruction with free jejunal flap for circumferential defects of hypopharynx and cervical esophagus were satisfying.Multidisciplinary cooperation is helpful to improve surgical success rate.Free jejunal flap is an ideal method for reconstruction of circumferential hypopharyngeal and cervical esophageal defects after removal of tumor.