Carcinomes épidermoïdes de l’hypopharynx et du larynx : prise en charge fondée sur les preuves

Squamous cell carcinomas of larynx and hypopharynx can be treated by surgery and/or radiotherapy according to tumor size. For small tumors, the results are similar. For locally advanced tumors, the surgical approach is mutilating and requires a total (pharyngo)laryngectomy. Exclusive chemoradiotherapy has shorow>n its interest at the cost of late sequelae. In order to reduce these effects and mutilation, induction chemotherapy row>ith cisplatin, docetaxel and 5FU for organ preservation becomes the standard treatment but there are no solid studies comparing this approach row>ith the exclusive chemoradiotherapy. And it is not possible to conclude as to the superiority of a scheme in terms of overall survival. ROW>hen chemotherapy is chosen, the modalities of any potentiation of radiation have not been yet established.     

游离空肠移植术重建颈部食管、下咽并发症分析

目的探讨游离空肠移植下咽及颈部食管重建术中常见并发症及其防治措施。方法选用10条比格犬(Beagle)行游离空肠移植下咽及颈部食管重建术,术中以空肠血管与甲状腺前动脉及颈外静脉行端-侧、端-端吻合,空肠移植颈部下咽、食管重建,观察并发症发生情况。结果术后6条实验犬手术成功,存活4w以上并能够正常饮食,术后移植空肠血供良好;4条犬出现并发症而死亡。结论游离空肠移植技术可以重建颈部组织缺损的修复,术前准备充足、术中操作细腻、术后观察及护理及时可以减少并发症,提高手术成功率,是颈部缺损修复最为理想的方法。     

Comparison of free jejunal graft with gastric pull-up reconstruction after resection of hypopharyngeal and cervical esophageal carcinoma

SUMMARY.  The purpose of this study is to evaluate the operative outcomes of a gastric pull-up and free jejunal graft reconstruction after resection of hypopharyngeal and cervical esophageal carcinoma. Records of all patients who underwent esophageal resection for carcinoma of the hypopharynx and cervical esophagus were reviewed. Reconstruction after esophagectomy was performed using the gastric pull-up ( n  = 38) or free jejunal graft ( n  = 14) techniques. The hypopharynx was the most common primary tumor site for the free jejunal graft group, whereas the gastric pull-up group had lesions more frequently in the cervical esophagus ( P  < 0.05). Both operative time and blood loss in the gastric pull-up group were significantly longer and excessive than those of the free jejunal graft group ( P  < 0.05). The graft survival rate was 95% (32/34) in the gastric pull-up group and 93% (13/14) for the free jejunal transfer group. The overall leakage rate was 1.9% (1/52). Three patients died (6%) in the postoperative period. There was no significant difference with regard to operative morbidity and mortality between the gastric pull-up group and free jejunal graft group. In conclusion, both free jejunal graft and gastric pull-up are safe and effective methods for the immediate restoration of alimentary continuity.     

VEGF-C及其受体FLT-4在喉及下咽癌淋巴转移中的作用

目的:研究喉及下咽部鳞癌组织中血管内皮生长因子-C(VEGF-C)及其受体VEGFR-3(FLT-4)在肿瘤淋巴转移中的作用和意义.方法:采用免疫组织化学SP法及图像分析,检测49例喉及下咽癌组织中VEGF-C、FLT-4的蛋白表达和相对含量.结果:49例喉及下咽部鳞癌组织VEGF-C表达阳性率为69.4%(34/49),FLT-4的阳性率为44.9%(22/49),其表达与VEGF-C阳性表达呈同向性改变.VEGF-C的表达强度与淋巴结转移密切相关(P＜0.05),与淋巴结转移之间存在相关关系(r=0.342,P＜0.05).淋巴结转移组FLT-4染色阳性脉管数较无转移组有增高趋势(P＜0.05);FLT-4的表达与淋巴结转移相关(r=0.312,P＜0.05).结论:VEGF-C在喉及下咽部鳞癌中,通过其特异性受体FLT-4,导致淋巴管的增生,促进肿瘤淋巴转移,从而影响患者的预后.检测VEGF-C(FLT-4),对肿瘤诊断、判断患者预后具有重要临床价值.