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。

Reconstruction for advanced hypopharyngeal carcinoma and laryngeal recurrent carcinoma

Objective To explore how to repair the hypopharyngeal and cervical defects after carcinoma removal in patients with hypopharyneal carcinoma of the advanced stage and laryngeal recurrent carcinoma.Method 36 cases of recurrent laryngeal carcinoma were treated.The defects of 18 cases were repaired with pectoralis major flaps,of 4 with deltopectoralis skin flaps,of 2 with stomach replaced esophagus and of 12 with the flap shift from thoraces to cover the dead space.Also 16 cases of late hypopharyngeal and eight cases of cervical esophageal carcinoma were treated in this study.The defects of 1 case was repaired with jejunal interposition,of 8 with laryngeal mucosal flaps from the uninjured side,of 8 with laryngotracheal interpositions,of 2 with pectoralis major flaps,of 2 with stomach replaced esophagus,and of 1 with a free antebrachial flap.Results No one died during the operations and no reconstructed tissue necrosishappened after the operations.All flaps survived.In cases repaired with laryngeal mucosal flaps,only 1 with pre-operational radiotherapy suffered from pharyngeal fistula.1 case was repaired with a pectoralis major flap and 1 with a stomach replaced esophagus suffered from a pharyngeal fistula.All patients could intake semi-fluid after healing.Followed up for 9 to 84 months,14 patients had dysphagia but still could intake semi-fluid.Conclusions All kinds of ways to reconstruct the defect of hypopharynx are good in different aspects and have different indications.Location of the tumor and size of the defects are the most important factors for choosing the reconstruction method.Also,complications should be decreased.