下咽癌喉癌术后广泛下咽及颈段食管缺损修复方法的比较

目的：探讨4种方法Ⅰ期修复下咽癌及晚期喉癌术后广泛下咽及颈段食管缺损的适应证及治疗效果。方法：用健侧喉黏膜瓣修复部分咽部缺损12例(伴颈段食管切除术2例)．胸大肌皮瓣修复部分咽部缺损6例，游离前臂皮瓣修复保留喉的部分下咽切除术2例．游离空肠重建全下咽和食管上段缺损1例。结果：术中无一例死亡，术后无修复组织坏死．全部组织瓣存活。采用健侧喉黏膜瓣修复者，仅1例术前放疗的患者术后发生咽漏；胸大肌皮瓣修复者，1例发生咽漏。全部病例愈合后均可进普通饮食。随访9～84个月，4例出现吞咽梗阻。结论：下咽癌缺损的修复方法各有侧重。肿瘤的部位和大小是选择修复方法最重要的因素；其次，也应仔细考虑减少并发症。

Surgical management of carcinoma of the hypopharynx and cervical esophagus

Objective:To report our experience in reconstructing hypopharynx and cervical esophagus with four kinds of operations.Method:Twenty one patients underwent reconstruction of the hypopharyngeal and cervical esophagus defect using contralateral hemilaryngeal mucosa flap,pectoralis major myocutaneous flap,forearm free flap and jejunal free flap.Result:All of cases were successful. Postoperative pharyngocutaneous fistulas occurred in two patients,which resolved spontaneously.All of patients can swallow ordinary food and had no benign strictures after operation.Conclusion:Every operation style has advantage and disadvantage. We had to select the operation of choice depending upon the location and size of the carcinoma,perioperative complication.