喉咽癌外科切除后应用喉气管瓣及其复合瓣重建上消化道

目的探讨喉咽癌病变被切除后应用喉气管瓣及其复合瓣重建上消化道的合理性、可靠性、有效性及其近远期疗效。方法回顾性分析我科自2002年12月～2010年11月共94例喉咽癌患者的临床资料,男92例,女2例。临床诊断为梨状窝癌者69例,下咽后壁癌11例,环后癌9例和下咽及颈段食管癌5例。I期1例,II期9例,III期27例,IV期A 53例,IV期B 4例。单纯应用喉气管瓣重建上消化道者33例,应用喉气管瓣与胸大肌皮瓣复合瓣重建者61例。结果所有患者无1例手术死亡,多数患者在术后10～14 d开始经口进食,X线钡餐透视检查通过顺利。发生咽瘘15例（16.0%）,无一例发生狭窄或消化道梗阻。中位随诊期3.5年,1、3、5年生存率分别为94.4%,60.5%和39.3%。结论本术式是一个根治性手术,喉气管瓣及其复合瓣重建上消化道手术简便易行,功能效果良好,有高度实用性和良好的肿瘤效果以及低的并发症,适合于大多数晚期喉咽癌患者。

Upper alimentary tract reconstruction by laryngotracheal flap and its complex flap after resection of hypopharyngeal cancers

OBJECTIVE To study the rationality,reliability and efficacy of upper alimentary tract reconstruction by laryngo-tracheal flap and its complex flap after resection of hypopharyngeal cancers.METHODS From Dec.2002 to Nov.2010.,94 patients with hypopharyngeal cancer were underwent surgical treatment.There were 92 male and 2 female.There were 69 cases with pyriform sinus cancer,11 cases with posterior hypopharyngeal wall cancer,9 cases with postcricoid cancer and 5 cases with hypopharyngocervical esophageal cancer.According to the classification of UICC 2010,there were 1 case in stage I,9 cases in stage II,27 in stage III and 53 cases in stage IV a,4 cases in stage IV b.Thirty three of 94 patients were underwent upper alimentary tract reconstruction by laryngo-tracheal flap alone and 61 patients by complex laryngo-tracheal with pectoralis major myocutaneous flap.RESULTS All of the 94 cases were underwent operation successfully without mortality.Most of the patients resumed regular diet 10-14 days after operation.Their swallowing function restored to normal by X-ray examination.The pharyngocutaneous fistulas were found in 15（16.0%）patients,and no stenosis or atresia of the upper alimentary tract were found.The median followup was 3.5 years,the 1,3 and 5 year survival rates were 94.4%,60.5% and 39.3% respectively.CONCLUSION Laryngotracheal flap and its complex flap is a simple and safe method for upper alimentary tract reconstruction after resection of hypopharyngeal cancer and can get satisfied oncological and functional results.The technique has low morbidity and suitable for most patients with advanced hypopharyngeal cancer.