气管造口复发癌的手术治疗

目的：探讨气管造口复发癌的治疗方法。方法：气管造口复发癌患者共31例，对怀疑有颈淋巴结转移的12例行改良根治性颈清扫术。Ⅰ、Ⅱ型气管造口复发癌共25例，均彻底切除肿瘤；Ⅲ、Ⅳ型共6例，3例彻底切除肿瘤。31例均采用胸大肌肌皮瓣修复颈部组织缺损。结果：Ⅰ型13例中，随访满3年者7例，死亡4例。Ⅱ型12例中，随访满3年者8例，死亡5例。Ⅲ、Ⅳ型多在3年内死亡。31例中，咽瘘发生率为12．9％，气胸发生率为9．7％。结论：气管造口复发癌预后较差，对适合的病例行适当的手术治疗可延长患者生命，提高生存质量。

Surgical management of stomal recurrence

OBJECTIVE: To study effective treatment of stomal recurrence. METHOD: Thirty-one patients with stomal recurrence underwent surgical management. Twelve of them considered to have the probability of metastasis to regional lymphnodes underwent modified radical neck dissection. Twenty-five cases(I and II type) received complete tumor excision, but for III and IV type, only 50% (3/6) of the patients gained complete tumor excision. The surgical defects were repaired by pectoralis major myocutaneous flap in all the patients. RESULT: In 13 cases of type I, 7 cases had followed up for 3 years, 4 cases died, while in 12 cases of type II, 8 cases had followed up for 3 years, 5 cases died. Survival remains poor for III or IV type. Most of them died within 3 years after operation. The complication rate of pharyngeal fistula and pneumatothorax was 12.9% and 9.7%, respectively. CONCLUSION: The overall prognosis of stomal recurrence is dismal. A proper surgical treatment in some cases will prolong the lifetime and improve their quality of life.