咽食管严重狭窄和闭锁的手术治疗

目的　探讨咽、食管严重狭窄和闭锁的手术治疗方法及效果。方法　分析了 1983年 1月～ 2 0 0 1年 6月山东医科大学附属医院 (现山东大学齐鲁医院 )耳鼻咽喉科手术治疗的 2 7例咽、食管严重狭窄和闭锁病例 ,其中伴有喉狭窄 12例 ,颈段气管狭窄 1例。根据病因划分包括化学腐蚀伤 2 5例 ,外伤 2例。修复方式 :结肠上徙 2 0例 ,游离空肠移植 6例 ,单纯胸大肌肌皮瓣整复 1例。 12例喉狭窄中利用胸骨舌骨肌筋膜整复 8例 ,胸骨舌骨肌筋膜和会厌下移联合整复 4例。 1例颈段气管狭窄利用胸锁乳突肌肌骨膜瓣修复。结果　 2 7例中 2 5例恢复吞咽功能 ,2例失败。 12例喉狭窄 10例恢复喉的呼吸、发音及吞咽保护全功能 ,2例仅恢复喉的发音及吞咽保护功能 ;1例气管狭窄经手术整复 ,最终拔除气管套管。结论　结肠上徙适于治疗范围大、位置低的严重狭窄或食管闭锁 ;游离空肠移植需要在颈部有正常的食管腔及吻合血管 ;胸大肌肌皮瓣适于修复范围较局限的咽、颈段食管狭窄

Surgical management of benign pharyngo-esophageal stenosis

Objective To study the methods and outcome of surgical management for pharyngo esophageal stenosis Methods Twenty seven patients with pharyngo esophageal stenosis from January 1983 to June 2001 were reviewed Among 27 cases, there were 12 cases accompanied with laryngeal stenosis and one case accompanied with tracheal stenosis In terms of etiological factor, all patients were cataloged into two groups, i e 25 cases with chemo causis and 2 cases with trauma The repair methods included colon interposition in 20 patients, free jejunum transplantation in 6 patients and pectoralis major muculocutaneous flap in 1 patient In total 12 cases of laryngeal stenosis, sternohyoid myofascial flap was applied in 8 cases, and sternohyoid myofascial flap and epiglottis were applied in 4 cases Results Swallow function recovered in 25 cases and failed in 2 cases Laryngeal function recovered totally in 10 patients and partially in 2 patients with laryngeal stenosis The patient with tracheal stenosis recovered and decannulated Conclusion According to the foci of pharyngo esophageal stenosis, the colon interposition, the free jejunum transplantation and the pectoralis major myocutaneous flap can be applied respectively to restore normal physiological function