喉气管组织瓣在下咽癌累及颈段食管手术中的应用

Application of laryngotracheal tissue flap in surgery for hypopharyngeal carcinoma involving cervical esophagus

目的下咽癌累及颈段食管病变术中修复是关键。文中旨在探讨喉气管组织瓣在下咽癌累及上颈段食管手术后组织缺损修复中的应用效果。方法回顾性分析2014年1月至2018年12月东部战区总医院耳鼻咽喉头颈外科103例行下咽癌手术患者的临床资料。根据纳入标准和排除标准最终纳入15例行喉气管组织瓣修复的患者,进行术中喉气管瓣修复。分析随访结果及并发症结果,并进行生存分析。结果术后喉气管瓣及修复组织瓣无坏死。所有患者切口均I期愈合。14例患者术后2周内均恢复了吞咽功能,1例术后并发一过性小咽瘘,术后4周内痊愈,并恢复经口进食。术后2、3、5年生存率分别为68.5%、45.7%、22.9%。结论下咽癌累及颈段食管患者生存率较低;术中组织缺损选择性应用喉气管瓣修复,手术创伤相对小、并发症少、术后吞咽功能恢复时间较短,是一种比较理想的修复手段。

Objective Intraoperative repair of hypopharyngeal carcinoma involving cervical esophagus is the key.The purpose of this paper is to investigate the application effect of laryngotracheal tissue flap in the repair of tissue defects after surgery for hypopharyngeal cancer involving upper cervical esophagus.Methods The clinical data of 103 patients who underwent surgery for hypopharyngeal cancer in Department of Otorhinolaryngology Head and Neck Surgery,General Hospital of Eastern Theater Command from January 2014 to December 2018 were retrospectively analyzed.According to the inclusion and exclusion criteria,15 patients who underwent laryngotracheal tissue flap repair were finally included for intraoperative laryngotracheal flap repair.Follow-up results and complications were analyzed,and survival analysis was performed.Results There was no necrosis of laryngotracheal flap and repaired tissue flap after operation.All incisions healed by first intention.All 14 patients recovered swallowing function within 2 weeks after operation.One patient suffered from transient small pharyngeal fistula after operation,which recovered within 4 weeks after operation and resumed oral feeding.The 2-,3-and 5-year survival rates were 68.5%,45.7%and 22.9%,respectively.Conclusion The survival rate of patients with hypopharyngeal carcinoma involving cervical esophagus is low.The selective application of laryngotracheal flap in the repair of tissue defects during operation is an ideal repair method,with relatively small surgical trauma,fewer complications and shorter recovery time of postoperative swallowing function.