气管造口复发癌的手术治疗

Surgical management of stomal recurrence

目的 :探讨气管造口复发癌的治疗方法。方法 :气管造口复发癌患者共 31例 ,对怀疑有颈淋巴结转移的 12例行改良根治性颈清扫术。Ⅰ、Ⅱ型气管造口复发癌共 2 5例 ,均彻底切除肿瘤 ;Ⅲ、Ⅳ型共 6例 ,3例彻底切除肿瘤。 31例均采用胸大肌肌皮瓣修复颈部组织缺损。结果 :Ⅰ型 13例中 ,随访满 3年者 7例 ,死亡 4例。Ⅱ型 12例中 ,随访满 3年者 8例 ,死亡 5例。Ⅲ、Ⅳ型多在 3年内死亡。 31例中 ,咽瘘发生率为 12 .9%,气胸发生率为 9.7%。结论 :气管造口复发癌预后较差 ,对适合的病例行适当的手术治疗可延长患者生命 ,提高生存质量。

Objective:To study effective treatment of stomal recurrence.Method:Thirty-one patients with stomal recurrence underwent surgical management.Twelve of them considered to have the probability of metastasis to regional lymphnodes underwent modified radical neck dissection. Twenty-five cases(Ⅰ and Ⅱtype) received complete tumor excision, but for Ⅲ and Ⅳtype, only 50%(3/6)of the patients gained complete tumor excision. The surgical defects were repaired by pectoralis major myocutaneous flap in all the patients.Result:In 13 cases of type Ⅰ, 7 cases had followed up for 3 years, 4 cases died, while in 12 cases of type Ⅱ, 8 cases had followed up for 3 years, 5 cases died. Survival remains poor for Ⅲ or Ⅳtype. Most of them died within 3 years after operation. The complication rate of pharyngeal fistula and pneumatothorax was 12.9% and 9.7%, respectively.Conclusion:The overall prognosis of stomal recurrence is dismal. A proper surgical treatment in some cases will prolong the lifetime and improve their quality of life.