游离空肠移植重建下咽颈段食管临床观察

目的:探讨游离空肠移植重建下咽颈段食管的可行性、技术操作方法及疗效。方法:回顾性分析采用游离空肠重建下咽颈段食管11例,其中喉癌术后复发1例,颈段食管癌2例,下咽癌8例。术中切除喉、下咽、颈段食管及部分颈段气管1例,切除喉、下咽及颈段食管8例,保留喉切除颈段食管2例。所有病例均给予颈淋巴清扫。术后放射治疗3例,剂量50~55Gy。结果:术后除1例移植肠管坏死改用前臂游离桡侧皮瓣卷成皮管移植重建外,其余10例均成活,成功率为90.9%。肠管成活病例中无咽瘘、感染等并发症发生,随访3~27个月,喉癌术后复发患者1例术后2个月肿瘤再发,出现吞咽梗阻。结论:游离空肠移植重建下咽颈段食管手术成功率高,恢复消化道的连续性安全可靠,内侧为黏膜的空肠瓣是下咽颈段食管极好的修复材料。

The jejunal free flap for reconstruction of hypopharyngeal and cervical esophageal defects

Objective:To study the feasibility,the surgical techniques and the results of the jejunal free flap for reconstruction of hypopharyngeal and cervical esophageal defects.Methods:Retrospective review of the archives of 11 patients who underwent hypopharyngeal and cervical esophageal reconstruction with free jejunal interposition from 2003 to 2005.Of the 11 patients,one patient who suffered from advanced recurrent cancer of larynx was given resection of the larynx,hypopharynx,cervical esophagus and partial cervical trachea;two patients who suffered from cervical esophageal carcinoma were only given resection of cervical esophagus,their larynx and hypopharynx retained;and the other eight patients who suffered from hypopharyngeal carcinoma were given performed resection of the larynx,hypopharynx and cervical esophagus.Neck dissection was carried out for all patients.Three patients received 50-55Gy postoperative radiotherapy.Results:Flap loss appeared in only one patient who was reconstructed with radial forearm free flap.Overall success rate was 90.9%(10/11).For successful cases,swallowing was resumed 10 days after the operation without salivary fistula and infection.The overall follow-up was from 3 to 27months and one patient with advanced recurrent cancer of larynx couldn't swallow after 2 months because of recurrence of cancer.Conclusion:Successful rate of reconstruction of hypopharyngeal and cervical esophageal defects with the jejunal free flap was high.Free jejunal flap is a safe and dependable procedure that will restore gastrointestinal continuity.The mucosal lined flap represents an excellent anatomic and physiologic replacement for the hypopharynx and cervical esophagus.