下咽及颈段食管癌的外科治疗

目的探讨下咽及颈段食管癌的外科治疗途径。方法分析１９８０年以来７６例下咽及颈段食管癌的外科治疗,其中位于下咽者３１例,颈段食管者４５例。结果下咽癌的切除率为９８６％（３０／３１）,食管重建包括口底食管吻合３例;咽、喉及颈段食管切除后用颈阔肌皮瓣重建１２例、游离空肠间插３例,全咽、全喉、全食管切除后用胃重建１２例。颈段食管癌的切除率为９１％（４１／４５）,除１例外均采用非开胸食管切除后用胃重建食管。术后并发症的发生率在用胃重建的５２例为３６５％（包括１例术后死于心力衰竭）,游离空肠者３３３％,颈阔肌皮瓣重建者为１６７％。随访２～１０８个月（平均５６５个月）,下咽癌的１、３、５年生存率分别为７９３％、６０％和３１６％,颈段食管分别为６８３％、９５％和０。结论下咽及颈段食管癌的切除率甚高,但下咽癌的远期疗效明显优于颈段食管癌。咽、喉及颈段食管切除后采用颈阔肌皮瓣重建是一种安全、有效的手术方法,并发症少,远期效果优良。

Surgical treatment of the hypopharyngeal and cervical esophageal carcinoma

OBJECTIVE: To review the experience of surgical treatment of hypopharyngeal and cervical esophageal carcinoma. METHOD: Seventy-six patients with squamous-cell carcinoma of the hypopharynx and cervical esophagus underwent surgery in our department from 1980 to June 1997. The site of the tumour was in hypopharynx in 31 patients and in cervical esophagus in 45. RESULT: The resectability rate of hypopharyngeal carcinoma (HPC) was 98.6% (30/31). The types of the esophageal reconstruction included pharyngo-esophageal anastomosis (3 patients) platysmamyocutaneous flaps reconstruction (PMFR) (12) free jejunal interposition (3) and gastric tube transposition following total pharyngolaryngo esophagectomy (12). The resectability rate of cervical esophageal carcinoma (CEC) was 91% (41/45). The esophageal construction applied gastric tube after esophagectomy without thoracotomy except one. The postoperative morbidity was 36.5% for gastric tube reconstruction (including one died of heart failure), 33.3% (1/3) for free jejunal interposition and zero for PMFR. The overall follow-up was from 2 to 108 months (median: 56.5 months) and the 1-, 3-, 5-year survival rates were 79.3%, 60% and 31.6% respectively for HPC and 68.3%, 9.5%, 0% respectively for CEC. CONCLUSION: Our data demonstrated that the resectability rate of the HPC and CEC was quite high but the long-term result of HPC was better than that of CEC. The PMFR after pharyngolaryngo-cervicalesophagectomy was a safe, effective operation with low morbidity and excellent long-term results.