残喉黏膜瓣在下咽癌手术修复中的应用

Application of residual laryngeal mucosa flap in surgical repair of hypopharyngeal carcinoma

目的探讨残喉黏膜瓣在下咽癌手术修复中的应用。方法收集2015年9月—2017年9月蚌埠医学院第一附属医院耳鼻咽喉头颈外科行残喉黏膜瓣修补下咽缺损的下咽癌修复手术患者48例。TNM分期为,T2N0M08例,T2N1M07例,T2N2M07例,T3N0M010例,T3N1M09例,T3N2M06例,T4N2M01例。根据肿瘤的原发位置部位选择手术入路:会厌谷、梨状窝外侧壁或尖部三种路径进入咽腔,切除范围距肿瘤1.5~2.0 cm,切缘快速冰冻检查,利用残存喉黏膜瓣进行下咽缺损修复。评估患者病情变化及身体状况,术后1个月行放疗或化疗治疗。结果48例患者均在短期内恢复正常吞咽功能。其中3例患者于术后6 d发现局部感染和咽瘘,咽瘘<2 cm,占6.25%(3/48),经局部换药2周内愈合;2例患者术后出现吻合口狭窄,6.25%(2/32),经相应扩张后好转。其中16例患者为全喉切除,术后呼吸通畅;28例患者于术后3个月内拔除气管套管,2例患者于术后6个月拔管,拔管率94%(30/32)。2例患者术后喉腔狭窄,无法拔管。2例3年内局部复发+颈部转移+远处转移(肺转移);1例3年内局部复发+食管转移;1例患者抑郁(自行脱管),5例失访。3年生存率为81.3%(39/48)。结论利用残喉黏膜瓣修补部分下咽癌切除术后的下咽缺损,就近取材,不增加切口、创伤不大,抗感染能力强、易成活,并发症相对较少。

Objective To explore the application of residual laryngeal mucosa flap in surgical repair of hypopharyngeal carcinoma.Methods Total 48 patients with hypopharyngeal cancer who underwent hypopharyngeal defect repair with residual laryngeal mucosal flap in the Department of Otolaryngology Head and Neck Surgery,the First Affiliated Hospital of Bengbu Medical College from September 2015 to September 2017 were collected.The TNM stages of 48 patients were T2N0M08 cases,T2N1M07 cases,T2N2M07 cases,T3N0M010 cases,T3N1M09 cases,T3N2M06 cases and T4N2M01 cases.According to the primary location of the tumor,the surgical approaches were selected:epiglottis valley,lateral wall or tip of pyriform fossa entering the pharyngeal cavity.The resection range was 1.5-2.0 cm from the tumor.The cutting edge was quickly frozen and the residual laryngeal mucosal flap was used to repair the hypopharyngeal defect.Evaluate the changes of patients’condition and physical condition,and receive radiotherapy or chemotherapy one month after operation.Results All 48 patients recovered normal swallowing function in a short time.Local infection and pharyngeal fistula were found in 3 patients 6 days after operation.The pharyngeal fistula was less than 2 cm,accounting for 6.25%(3/48),and healed within 2 weeks after local dressing change.Anastomotic stenosis occurred in 2 patients(6.25%,2/32)after operation,and improved after corresponding expansion.Among them,16 patients underwent total laryngectomy and breathed smoothly after operation.Tracheal cannula was removed in 28 patients within 3 months after operation,and extubation rate was 94%(30/32)in 2 patients 6 months after operation.The laryngeal cavity of 2 patients was narrow after operation,which made it impossible to extubate.Local recurrence+cervical metastasis+distant metastasis(lung metastasis)occurred in 2 cases within 3 years.Local recurrence+esophageal metastasis occurred in 1 case within 3 years.One patient was depressed(self-catheter removal),and 5 patients lost follow-up.The 3-year survival rate was 81.3%(39/48).Conclusion Repairing hypopharyngeal defect after partial hypopharyngeal cancer resection with residual laryngeal mucosa flap has the advantages of taking materials nearby,not increasing incision,less trauma,strong anti-infection ability,easy survival and relatively few complications.