自体游离空肠重建喉咽及颈段食管

目的探讨自体游离空肠移植重建喉咽及颈段食管的临床应用。方法回顾性研究1999年8月～2006年8月共进行的9例喉咽和(或)颈段食管肿瘤切除、自体游离空肠移植食管和(或)喉咽重建术病例。总结手术适应证的选择、手术方法、围手术处理方法及手术效果。结果9例患者移植游离空肠全部存活,无咽瘘、颈部感染或吻合口狭窄等颈部并发症。2例成功保留喉功能。9例患者最长随访时间37个月,最短22个月。1例患者术后22个月时发现舌根部肿瘤复发,经放射治疗后好转,术后25个月失访。1例患者术后17个月因肿瘤复发死亡。其余7例存活,无吞咽困难,未见肿瘤复发。结论正确的适应证选择,合理的围手术期处理,以及熟练的小血管吻合技术是游离空肠移植重建喉咽和颈段食管,治疗晚期喉咽癌、颈段食管癌成功的保证;再次证明,游离空肠移植重建喉咽和颈段食管不仅为肿瘤完全切除并一期重建提供技术保障,还能提高患者的无瘤生存率和生存质量。

Free jejunal graft for hypopharyngeal and cervical esophageal reconstruction

OBJECTIVE To assess the appli- cation of free jejunal graft for reconstruction of hypopharynx or cervical esophagus during advanced hypopharyngeal and cervical esophageal carcinoma resection.METHODS The clinical data of 9 cases with advanced hypopharyngeal and/or cervical esophageal cancers used free jejunal grafts for reconstruction of the defect from August 1999 to August 2006 were retrospectively studied.The indications, selection of the patients,perioperative management and operative techniques for the operations were summarized.RESULTS All the free jejunal grafts had been alive in 9 patients without perioperative complications and mortality.A good laryngeal function was preserved in 2 patients.All the patients have been followed up for 22 to 37 months.One of them was found a tumor in the base of tongue 22 months after operation,and failed to follow up 3 months later. Another patient was died of tumor recurrence 17 months after operation.The remained 7 patients were survived well without difficulty in deglutition,and no recurrence.CONCLUSION For reconstruction of hypopharynx or cervical esophagus,the free jejunal graft is a very useful method not only for total resection of the tumor,but also for improving the patient's quality of life.