管状胃上提术在下咽颈段食管癌术中的临床应用

目的 探讨管状胃上提术在下咽颈段食管癌术中的应用，并分析其临床特征。方法 回顾性分析5例下咽颈段食管癌术患者行管状胃上提术的临床资料，其中下咽颈段食管癌初发者4例，复发者1例。结果 患者采用胸腔镜辅助下管状胃上提术4例，达芬奇机器人辅助下管状胃上提术1例。保留喉功能全咽全食管切除2例，喉全切+全咽+全食管切除3例；术后病理为鳞状细胞癌4例，腺癌1例；术后一过性胸腔瘘1例，术后放疗后咽瘘1例；术后1个月内全部恢复经口饮食。随访6~44个月，死亡3例(术后6个月因肺转移癌肺出血死亡1例，术后13个月因局部复发并发心衰死亡1例，术后44个月因食管、肺转移并发恶液质死亡1例)；带瘤生存2例(术后1年肺转移1例，术后3个月颈淋巴结转移、术后11个月腹腔淋巴结及肾上腺转移1例)。结论 下咽颈段食管癌恶性程度高，腺癌少见，胸腔镜或达芬奇机器人辅助下咽颈段食管癌术中管状胃修复术在围手术期并发症可控，值得推荐应用。

Gastric pull-up reconstruction after hypopharyngo-esophagectomy for carcinoma of hypopharynx and cervical esophagus

Objective To investigate the application of gastric pull-up reconstruction after hypopharyngo-esophagectomy and analyze the clinical characteristics of carcinoma of hypopharynx and cervical esophagus.Methods Clinical data of 5 patients with gastric pull-up reconstruction after hypopharyngo-esophagectomy for carcinoma of hypopharynx and cervical esophagus were retrospectively analyzed.Results Of all the 5 cases, 4 were newly diagnosed and one was recurrent. The gastric pull-up reconstruction was assisted with thoracoscope in 4 cases and Da Vinci robot in one. Hypopharyngo-esophagectomy with reserved laryngeal function was carried out in 2 cases, and hypopharyngo-laryngo-esophagectomy was performed in 3. Postoperative pathological diagnosis revealed 4 cases of squamous cell carcinoma and one of adenocarcinoma. Postoperative transient thoracic fistula occurred in one case, pharyngeal fistula after radiotherapy in another. All patients resumed oral intake within one month after surgery. The postoperative follow-up of 6 to 44 months revealed that 3 cases died, due to pulmonary hemorrhage 6 months postoperatively in one, local recurrence with heart failure 13 months in another, and esophageal and lung metastasis 44 months in one. Two patients survived with tumor including one with lung metastasis 1 year postoperative, and the other with cervical lymph node metastasis 3 months and abdominal lymph node and adrenal metastases 11 months postoperative.Conclusions The malignant degree of hypopharyngeal and cervical esophageal cancer is high, and adenocarcinoma is rare. With controllable perioperative complication, gastric pull-up assisted with thoracoscope or Da Vinci robot is worthy of recommendation for reconstruction after hypopharyngo-esophagectomy.