下咽癌术后下咽缺损修复方法的选择

目的 :探讨下咽癌术后下咽缺损Ⅰ期修复的方法。方法与结果 :对 31例下咽癌术后下咽缺损患者行Ⅰ期修复 ,其中下咽、喉和食管颈段切除加胃造瘘术 1例 ,无咽瘘发生 ;直接缝合修复 17例 ,吞咽功能良好 15例 (88.2 % ) ;组织移植修复 13例 ,吞咽功能良好 6例 (46 .2 % )。同时行喉功能保存性手术 14例 ,吞咽功能良好9例 ,均为直接缝合修复病例 ;吞咽功能差 5例 ,2例为直接缝合修复病例 ,3例为组织移植修复病例 ,均发生误吸。结论 :直接缝合大多数吞咽功能良好。对下咽全缺损的修复 ,胃肠上徙比肌皮瓣优越。同时行喉功能保存性手术 ,必须严格选择病例 ,并把误吸的预防放在首位。下咽、喉和食管颈段切除加胃造瘘术有助于扩大下咽癌的手术适应证。

Selection of methods of rehabilitation for hypopharyngeal defects after hypopharyngeal carcinoma removal

OBJECTIVE: To explore how to repair hypopharyngeal defects after hypopharyngeal carcinoma removal. METHOD: We analysed the methods of stage I rehabilitation for hypopharyngeal defects and deglutitory function in 31 cases carried out hypopharyngeal carcinoma operation in our department from June, 1996 to June, 2001. RESULT: 1 case was performed "zero rehabilitation". In 15 of 17 cases (88.2%) carried out with direct suture rehabilitation, deglutitory function is good. In 6 of 13 cases (46.2%) carried out with tissue graft rehabilitation, deglutitory function is good. In 9 of 14 cases carried out with preserved laryngeal operation synchronously, deglutitory function is good(all direct suture rehabilitation). There were 5 cases with worse deglutitory function(each case occured inhalational error, 2 of them were direct suture rehabilitation and 3 of them were, issue graft rehabilitation). CONCLUSION: Patients obtain a better deglutitory function after direct suture rehabilitation. For total hypopharyngeal defects, stomach/intestines pull-up is superior to myocutaneous flap transposition. For synchronous preserved laryngeal operation, we should pay more attentions in case selection and inhalational error prevention. "Zero rehabilitation" is helpful to enhance the indication of surgical treatment for hypopharyngeal carcinoma.