侵犯食管上端的下咽癌的手术治疗

目的 探讨下咽癌侵犯食管上端的手术治疗价值。方法 1998年1月～2003年1月间17例侵犯食管上段的下咽癌病例(梨状窝癌13例，下咽后壁癌4例)，行根治性放疗8例；手术治疗9例，其中2例行下咽、全喉、全食管切除和咽胃吻合术，7例行下咽、全喉、食管上端切除、舌瓣和胸大肌肌皮瓣重建下咽及颈段食管，术后放疗。8例并行双侧功能性颈清扫术，1例行同侧颈清扫术。患者出院后全部随访。结果 9例手术加放疗患者术后1例吻合口狭窄；8例均能经口进食，日常生活自理；9例均应用电子喉可进行交流；5例已死亡，中位生存期29个月。8例根治性放疗者6例已死亡，中位生存期13个月。结论 下咽、全喉、全食管切除并胃咽吻合术，或下咽、全喉、食管上端切除、舌瓣和胸大肌肌皮瓣重建下咽及上段食管，辅以术后放疗治疗下咽癌侵犯上端食管的方法可行，预后较单纯放疗好，但生活质量欠满意。

Surgical management of hypopharyngeal carcinoma violating proximal esophagus

Objective To evaluate the clinical value of laryngo-pharyngectomy and partial or total-esophagectomy and two repairing ways for hypoparyneal carcinoma violating proximal esophagus. Methods Seventeen patients were reviewed from 1998 to 2003 , including 8 cases with single radiation,9 cases with operation and radiation .Follow-up were made in all patients. Results Postoperative complications included anastomotic stricture in one case. Functional outcomes in 8 cases including daily activities and swallowing function were acceptable. The mean survival time was from 11 to 43 months with a median survival time of 29 months in 9cases with operation and radiation. The mean survival time was from 7 to 23 months with a median survival time of 13 months in 8 cases with single radiation. Conclusion Comparison of single radiation, the operation with radiation has better effectiveness for hypopharyngeal carcinoma violating proximal esophagus.