下咽癌的外科治疗

Surgical Treatment of Hypopharyngeal Carcinoma

目的探讨下咽癌的手术治疗以及保留喉功能的可能性。 方法 7例下咽癌患者予手术治疗 ,切喉组 4例行全喉切除、食管拔脱、下咽癌根治、胃代食管术 ;保喉组 3例行食管拔脱、下咽癌根治、胃代食管术。所有病例行同期颈淋巴结清扫 ,术后 5例行辅助放疗。 结果 1例术后血胸 ,无 1例发生吻合口瘘 ,所有病人均治愈出院。随访 1年内死亡 1例 ,2年内死亡 1例 ,其余还在随访中。 结论改良下咽癌的根治性手术治疗有良好的远期疗效 ,对保留喉功能应视病情而定。

Objective To study the optimum surgery for hypopharyngeal carcinoma and feasibility to preserve laryngeal function. Methods The records of 7 surgically curative patients with hypopharyngeal carcinoma were reviewed. Four patients underwent gastric pull-up for pharyngogastric anastomoses after pharyngolaryngectomy and total esophagectomy, and 3 only underwent total esophagectomy with gastric pull-up for reconstruction of the digestive tract. All patients had lymph node dissections and 5 patients received a post operative course of radiotherapy. Results There was no anastomotic leakage, nor postoperative in-hospital mortality. Only one patient had complication of hemothorax. One patient died in the first year after operation and another in the second year. Others are still in the follow up. Conclusion Surgical treatment of hypopharyngeal carcinoma without pharyngolaryngectomy may be an effective treatment modality. This la rynx -preserving surgery is recommended for patients without tracheal invasion.