下咽及颈胸段食管多原发癌一期手术

目的 探讨下咽、颈胸段食管多原发癌（multiple primary carcinoma,MPC）在胸腔镜辅助下行全喉、下咽、食管切除并管状胃重建一期手术的应用及疗效。方法 胸科组行胸腔镜辅助下分离食管及纵膈淋巴结清扫后开腹行管状胃成形,头颈组行颈部淋巴结清扫、全喉下咽切除、咽胃吻合术。术后常规补充放化疗。结果 本组全部病例均一期完成手术,肺部感染3例,胸腔积液2例、气管撕裂1例;无吻合口瘘及围手术期死亡病例;3年生存率63.6%,5年生存率50.0%。结论 下咽癌应常规行胃镜检查以免MPC的漏诊;胸腔镜辅助下全喉、下咽、食管切除并管状胃重建术可一期完成以往分次手术难以完成的手术治疗,有效提高下咽颈胸段食管多重癌的治疗效果。     

持续封闭负压引流处理咽瘘的效果观察

目的 评估持续封闭负压引流处理咽瘘的效果。方法 回顾性分析2019年6月—2021年11月于山东省立医院耳鼻咽喉头颈外科因喉癌、下咽癌、下咽癌合并食管癌、颈段食管癌行肿瘤切除并咽部直接吻合修补或使用组织瓣、管状胃、游离空肠等行咽部修复的患者117例，其中咽瘘者18例，咽瘘患者均用持续封闭负压引流方式处理咽瘘,分析其治疗过程及其术后疗效。结果 18例咽瘘患者中，发现咽瘘时间为术后第4~26天，中位时间9 d；咽瘘持续时间为10~52 d，中位时间20 d。所有咽瘘患者咽瘘口均用持续封闭负压引流方式保守治疗愈合，均无需再行手术修补。结论 持续封闭负压引流可减轻咽瘘患者痛苦、减少医师换药操作时间、缩短咽瘘持续时间，减少咽瘘发展至手术修补的几率。     

颈段食管癌手术喉功能保留问题的探讨

目的:探讨颈段食管癌手术喉功能保留的适应证和咽食管重建方法, 以及胃咽吻合术误吸并发症的原因和防治措施.方法:9例保留喉功能的颈段食管癌手术患者,其中单纯颈段食管癌2例,颈段食管癌侵犯下咽部6例,颈胸段食管重复癌1例.喉功能保留:全部喉功能保留8例,部分喉功能保留1例.下咽-食管重建:胃咽吻合7例,游离前臂皮瓣1例, 胸大肌皮瓣1例.结果:喉功能恢复良好4例,中等2例,差3例.胃咽吻合术7例均发生不同程度的胃液反流、咳嗽反射暂时性消失和误吸,5例发生声带麻痹;吻合口越高,误吸程度越重.游离前臂皮瓣移植术1例死于大出血.胸大肌皮瓣转移术1例虽能恢复良好的喉功能,但6个月后发生吻合口狭窄.结论:单纯颈段食管癌和颈段食管癌向上侵犯下咽部1 cm以内的患者适宜行全部喉功能保留手术;而颈段食管癌向上侵犯下咽部部1 cm以上的高龄患者不宜行全部喉功能保留手术,可行部分喉功能保留手术或不保留喉功能手术.胃咽吻合术误吸并发症的发生与咽-食管吞咽功能障碍和喉防误吸功能障碍密切相关.     

颈段食管癌的外科治疗16例临床分析

目的：探讨颈段食管癌的外科治疗方法及保留喉功能手术治疗的意义及可行性。方法：回顾性分析手术治疗颈段食管癌患者16例的临床资料,手术方式中,喉及喉咽全部切除食管内翻拔脱管状胃代食管术12例;喉及喉咽全部切除＋颈段食管切除气管代食管术1例;部分下咽＋颈段食管切除喉气管瓣代食管术1例;保留喉的食管内翻拔脱管状胃代食管术2例。均同期行双侧颈廓清术。结果：无手术死亡,手术切除率100％。术后并发肺部感染2例,吻合口瘘2例,吻合口狭窄2例,心功能衰竭1例,失访3例。喉功能保留率12．5％。3年生存率30．7％,5年生存率23．1％。结论：颈段食管癌可行非开胸食管内翻拔脱术切除肿瘤,以管状胃、喉气管瓣修复食管缺损,根据肿瘤所在部位及侵及范围,尽可能保留喉功能。     

喉癌下咽癌患者下咽及颈段食管术后缺损的修复方法

目的 :探讨喉癌下咽癌患者下咽或下咽及颈段食管术后缺损的修复方法。方法 :对保留喉功能的下咽术后缺损 9例 (伴颈段食管部分切除 3例 ,颈段食管癌行食管全切除 1例 ) ,用胸大肌肌皮瓣修复 4例 ,直接修复 4例 ,胃咽吻合术 1例。不保留喉功能 2 0例 (伴颈段食管部分切除 2例 ) ,舌瓣修复 16例 ,喉组织瓣 2例 ,胸大肌肌皮瓣与胸骨舌骨肌筋膜瓣联合重建下咽 2例。结果 :术后 8例Ⅰ期恢复吞咽及喉功能 ,1例下咽狭窄 ,Ⅱ期行残喉切除。余 2 0例中 16例Ⅰ期恢复吞咽功能 ,1例下咽狭窄经扩张进食 ,3例咽瘘 ,其中 1例咽瘘行Ⅱ期胃咽吻合术。 1、3及 5年的生存率分别为 92 %、6 4 .7%和 4 6 .2 %。结论 :保留喉功能的下咽或下咽及颈段食管缺损可直接修复或采用胸大肌皮瓣修复 ,不保留喉功能者 ,可采用舌瓣、胸大肌皮瓣修复或咽胃吻合术。肌皮瓣和肌筋膜瓣联合重建全下咽易引起下咽狭窄或咽瘘     

胃管状成形术在晚期下咽及颈段食管癌手术中的应用

目的 探讨胃管状成形术在晚期下咽及颈段食管癌切除术中的修复应用价值.方法 分析四川省肿瘤医院头颈外科2004年11月-2008年12月42例全下咽及颈段食管切除的患者予以胃管状成形后修复.结果 42例患者无围手术期死亡,无胃坏死、血胸等重大并发症.发生颈部吻合口瘘2例,吻合口狭窄2例,无胸胃综合征及严重反流性食管炎发生,所有患者恢复吞咽功能,正常进食.随访0.5～4年,中位随访时间为26个月.1年和3年生存率分别为74.3%和48.3%.结论 胃管状成形用于全下咽及颈段食管癌切除修复,更加符合食管生理,缩小了胃的容积并延长了长度,减少胸胃内食物的潴留,减少对心肺的压迫及胸胃综合征的发生,并可直接吻合于舌根等较高的平面,为晚期下咽及颈段食管癌提供了一种简便可靠的修复方法 .     

喉气管复合组织瓣修复下咽颈段食管缺损(附12例报告)

目的探讨下咽颈段食管癌手术后组织缺损的修复方法.方法12例下咽、颈段食管癌行部分喉、下咽、颈段食管切除术后,应用健侧无软骨的喉气管复合组织瓣修复下咽和颈段食管缺损.结果10例患者切口一期愈合,2例切口感染并发咽瘘,1例术后1年死于肺转移.11例术后1月内恢复了吞咽功能,另1例行二期咽瘘修补术,效果满意.经随访1年、3年生存率分别为91.6%(11/12)和58.3%(7/12).结论喉气管复合组织瓣修复下咽和颈段食管缺损手术创伤小,并发症少,易推广.     

用硅橡胶管重建下咽及颈段食管缺损

目的重建下咽及颈段食管癌切除后缺损和治疗该部位的疤痕性狭窄和咽瘘。方法采用自行研制的医用硅橡胶管进行重建。在动物实验和１例患者病理学检查中，可见术后缺损处肉芽表面上皮化，形成新的管腔。结果应用于下咽及颈段食管癌２５例，良性狭窄及咽瘘修补５例中，术后并发咽瘘６例（２０．０％）。随访５个月～４年（平均２．５年），已拔除硅橡胶管２５例，恢复吞咽功能及正常饮食２３例，再度发生狭窄２例；现带管观察２例。癌肿２５例中，术后３～６个月局部癌复发２例，颈淋巴结癌转移复发４例，该６例均在术后１年内死亡。另死于肺转移１例，因肺炎死亡２例。癌肿患者术后３年生存率５０．０％（５／１０）。结论下咽及颈段食管缺损１０ｃｍ以内者，此法效果满意。     

下咽癌、颈段食管癌切除后胃代食管术并发症分析

目的 :报告非开胸食管内翻拔脱后胃代食管术治疗下咽癌、颈段食管癌的术后并发症 ,探讨并发症的发生原因及预防措施。方法 :回顾性分析 1994年～ 2 0 0 0年间对 2 1例下咽癌、颈段食管癌病人行非开胸食管内翻拔脱后胃代食管术治疗情况。其中颈段食管癌 9例 ,全部保留喉功能 ;下咽癌 12例 ,其中 7例同时行喉全切除术 ,5例行喉部分切除术。全部病例均行幽门成形术。结果 :6例发生并发症 :吻合口瘘 1例 ,胃坏死 2例 ,肺炎 2例 ,心衰 1例。其中术后死亡 2例 ,并发症发生率 2 8.6 %。结论 :对并发症的发生原因、预防措施进行了讨论     

晚期喉咽癌侵犯颈段食管的围手术期处理

目的 :探讨晚期喉咽癌侵犯颈段食管患者的围手术期处理方法。方法 :侵犯颈段食管的 7例喉咽癌患者中 ,6例行一侧功能性颈廓清 ,喉下咽全切除 ,颈段食管剥脱 ,胃上徙 ,胃咽吻合术 ;1例行一侧根治性颈廓清 ,喉下咽全切除 ,颈段食管剥脱 ,胃大部切除 ,结肠上徙 ,结肠残胃、结肠咽吻合术。术中 5例切除一侧甲状腺。结果 :术后并发胃咽吻合口瘘 1例 ,急性肾功能衰竭 1例 ,所有患者均有不同程度的呕吐及其他消化功能不适 ,经治疗顺利度过围手术期。结论 :加强晚期喉咽癌侵犯颈段食管患者的围手术期处理 ,可使患者顺利接受术后放疗等综合治疗 ,提高肿瘤的治愈率和患者的生存率。     

Complication following gastric pull-up reconstruction for advanced hypopharyngeal or cervical esophageal carcinoma: a 20-year review in a Chinese institute

Objectives

Carcinoma of the hypopharynx and cervical esophagus is a very aggressive cancer with a high incidence of multifocal mucosal involvement and a high incidence of submucosal lymphatic spread. Total pharyngolaryngoesophagectomy and gastric pull-up reconstruction are often the procedures of choice. The aim of this study is to review the complication after gastric pull-up reconstruction in patients with advanced hypopharyngeal or cervical esophageal cancer.

Materials and methods

A total of 208 patients undergoing gastric pull-up reconstruction for squamous cell carcinoma of the hypopharynx invading the cervical esophagus and cervical esophagus at the Affiliated Provincial Hospital of Anhui Medical University in China from 1988 to 2007 were reviewed. Of 208 patients, 124 patients had hypopharyngeal carcinoma invading cervical esophagus; and 84 patients had cervical esophageal carcinoma. The analysis focused on the most common complications and the survival following gastric pull-up reconstruction. This study and its methods have been approved by the institutional review board.

Results

Of the 208 patients, 87 (41.8%) developed some complications, including anastomotic leak (19, 9.1%), pneumonitis (23, 11.1%), pleural effusion (15, 7.2%), wound infection (8, 3.9%), heart failure (4, 1.9%), anastomosis stricture (7, 3.4%), chylous fistula (4, 1.9%), hemothorax (3, 1.4%), hemoperitoneum (2, 1.0%), and burst abdomen (2, 1.0%); there was no gastric necrosis. In our cases, there was no immediate operative mortality; but there were 4 hospital deaths. The average hospital stay was 15 days.

Conclusions

Gastric pull-up reconstruction is a relatively safe and effective method and can be performed with low mortality and acceptable morbidity and result in good quality of lives.     

喉气管组织瓣在喉咽癌累及颈段食管手术中的应用

目的探讨喉气管组织瓣在喉咽癌累及颈段食管手术后组织缺损修复中的应用价值。方法回顾分析术者近5年利用喉气管组织瓣修复15例喉咽癌累及颈段食管术后组织缺损的临床资料,其中喉气管组织瓣合并单侧双蒂带状肌瓣修复10例、喉气管组织瓣加单侧双蒂带状肌瓣加椎前筋膜修复3例、喉气管组织瓣加单侧双蒂带状肌瓣加胸大肌肌皮瓣修复2例。上述病例中,喉咽缺损修复后用胸锁乳突肌加固4例。结果术后喉气管瓣及修复组织瓣无坏死。5例术后并发小咽瘘。1例术后8个月发现舌根复发,再次手术,13个月后死亡;1例术后18个月死于局部复发;1例术后13个月发现对侧II区转移,再次手术,健在;1例术后11个月肺转移,化疗,健在;1例术后36个月,发现气管造口后复发,再次放疗后仍健在。12例术后16天内恢复了吞咽功能,其中10例同时恢复较好的发音功能;5例咽瘘皆在1个月内愈合并恢复了吞咽功能。经随访3、5年生存率分别为61.5%、37.5%。结论喉咽癌累及颈段食管手术后组织缺损有选择性应用喉气管复合组织瓣修复,手术创伤小、并发症少、术后发音恢复快、质量好,是一种比较理想的修复手段。     

Cervical tracheoesophageal fistula

Four unusual cases of cervical tracheoesophageal fistula (TEF) are presented. The incidence, diagnosis and treatment of cervical TEF are discussed. Surgically, if the location is above the level of T2 a cervical approach may be utilized. The cases included a cervical "H" type TEF occurring in an adult. Congenital "H" type TEFs frequently occur in the neck. An adult presenting with a cervical "H" type TEF, having as an infant undergone repair of a thoracic TEF, is unique. Two layer closure of both trachea and esophagus with strap muscle interposition is preferred. The other cases include a TEF secondary to metastatic breast carcinoma, one associated with a stomal recurrence, and an acquired TEF following laryngectomy. Metastatic breast carcinoma resulting in a TEF is reported for the first time. Malignant TEF's are usually secondary to carcinoma of the esophagus, lung, or thyroid. Best palliation is achieved either by esophageal intubation, by colon bypass, or by gastric pull-up with esophageal exclusion. Stomal recurrence with TEF following laryngectomy is treated with one-stage resection and reconstruction with a pectoralis major myocutaneous flap and gastric pull-up. A patient 5 years post-laryngectomy illustrates an acquired non-malignant cervical TEF, a category which includes fistulas due to trauma, tracheotomy, or endotracheal tubes, instrumentation, and inflammatory disease. Prompt surgical closure as in congenital cases is the treatment of choice although select cases require medical therapy.     

Surgical treatment of laryngeal tumors with subglottic extension and tracheal tumors with composite nasal septal cartilage graft: technique and outcome

OBJECTIVE: Composite nasal septal cartilage grafts (CNSCG) are effective grafting materials in laryngeal and tracheal reconstruction following tumor resection. METHODS: Between 1985 and 2005, we used CNSCG for the reconstruction of defects following resection of laryngeal tumors with subglottic extension (20 cases), subglottic mesenchymal tumors (2 cases), invasive thyroid carcinoma (4 cases), tracheal tumors (3 cases) and esophagus carcinoma with tracheal invasion (1 case) in total of 30 patients. RESULTS: The patients with subglottic tumors were decanulated within 5-7 days except one case. We achieved satisfactory voice and swallowing without any sign of recurrence. Overall complications consisted of subglottic stenosis in one case, and unilateral paralysis of recurrent laryngeal nerve in two cases. One patient with subglottic laryngeal carcinoma died due to neck and distant metastases 4 years after the operation. All patients are well with a mean follow-up period 9 years. Three patients with tracheal tumors underwent lateral resection and reconstructed with CNSCG. Satisfactory healing of the grafts was seen in all cases without local recurrence or complication with a mean follow-up period of 62 months. One of the patients had distant metastases 3 years after the operation. The patient with esophagus carcinoma and tracheal invasion was treated by total esophagectomy, gastric pull-up, tracheal resection and CNSCG reconstruction. He died at postoperative 5th day due to mediastinitis as a complication of gastric pull-up. CONCLUSION: Free composite cartilage graft is a reliable material in the reconstruction of defects after surgery of laryngeal tumors with subglottic extension, invasive thyroid and esophagus tumors and well-selected tracheal tumors.     

Reconstruction of the hypopharynx with U-shaped pectoralis major myocutaneous flap after total pharyngo-laryngectomy

Resection of the whole circumference of the pharynx and esophagus is usually reconstructed with gastric pull-up, jejunum free graft or free forearm flap. The aim of this study was to assess the use of pectoralis major myocutaneous flap for closure of total pharyngeal defect. In 11 patients with hypopharynx and larynx cancer, total pharyngo-laryngectomy and excision of the cervical part of the esophagus and neck dissections were performed; the defects were closed with pectoralis major myocutaneous flaps. The skin island was sutured to prevertebral muscles, forming a letter U shape. Good healing was obtained in six patients, and five patients developed fistula that closed spontaneously within 3–4 weeks. The use of U-shaped pectoralis major myocutaneous flap, suturing it to prevertebral muscles, gives good functional results, and it is a simple and time-saving second choice method of reconstruction of the pharynx after total pharyngo-laryngectomy.     

下咽癌喉癌术后广泛下咽及颈段食管缺损修复方法的比较

目的：探讨4种方法Ⅰ期修复下咽癌及晚期喉癌术后广泛下咽及颈段食管缺损的适应证及治疗效果。方法：用健侧喉黏膜瓣修复部分咽部缺损12例(伴颈段食管切除术2例)．胸大肌皮瓣修复部分咽部缺损6例，游离前臂皮瓣修复保留喉的部分下咽切除术2例．游离空肠重建全下咽和食管上段缺损1例。结果：术中无一例死亡，术后无修复组织坏死．全部组织瓣存活。采用健侧喉黏膜瓣修复者，仅1例术前放疗的患者术后发生咽漏；胸大肌皮瓣修复者，1例发生咽漏。全部病例愈合后均可进普通饮食。随访9～84个月，4例出现吞咽梗阻。结论：下咽癌缺损的修复方法各有侧重。肿瘤的部位和大小是选择修复方法最重要的因素；其次，也应仔细考虑减少并发症。     

Gastric pull-up vs deltopectoral flap for reconstruction of the cervical esophagus

Reconstruction of the cervical esophagus and pharynx after a total laryngopharyngectomy for patients with advanced hypopharyngeal cancer still remains a problem for surgeons. The results of two procedures, the tubed deltopectoral flap reconstruction and the gastric pull-up operation with pharyngogastric anastomosis, which are used in fulfilling postoperative deglutition requirements, were compared. There were nine patients in the gastric pull-up group and eight patients in the deltopectoral flap group. The groups were reasonably comparable with regard to age, sex, preoperative radiotherapy, and stage of tumor. Three of the patients in the gastric pull-up group were operated on for palliation alone. Average operation-to-swallow time was 12 days for the gastric pull-up groups and 90 days for the deltopectoral flap group. Reconstruction of the gullet with the stomach pull-up operations seems to be superior to the tubed deltopectoral flap. This is especially true if the operation is palliative because the patient is unlikely to survive more than one year after surgery.     

晚期下咽癌、喉复发癌术后颈部缺损整复组织的选择

目的:探讨以不同组织移植物Ⅰ期重建晚期下咽癌、喉复发癌术后颈部、下咽食管缺损的适应证及治疗效果。方法:喉复发癌36例, 肿瘤切除后采用胸大肌肌皮 瓣修补组织缺损18例,肩胸皮瓣修补4例,胃代食管修补2例,胸部推移皮瓣重建下颈部与上纵隔组织缺损,并消灭手术死腔12例。晚期下咽癌16例,颈段食管癌8例,以游离空肠整复1例, 健侧喉黏膜瓣修复咽部缺损8例,喉气管代食道8例,胸大肌皮瓣修复咽部缺损2例,胃代食管2例,游离前臂皮瓣修复下咽1例。 结果:术中无一例死亡,术后无修复组织坏死 ,全部组织瓣存活。采用健侧喉黏膜瓣修复者,仅 1例有术前放疗史的患者发生术后咽漏,胸大肌皮瓣 修复者发生咽漏1例,胃代食道术后发生咽漏1例。全部病例愈合后均恢复正常饮食。随访 9～84个月,14例出现吞咽梗阻,可进流质饮食。结论:下咽癌患者术后组织缺损的修复方法各有侧重。肿瘤的部位和手术后组织缺损的大小是选择修复方法的首要因素;其次,应结合患者的年龄和全身状况,考虑减少并发症。