下咽、颈段食管癌手术切除后保留喉功能与发声重建

目的：探讨下咽、颈段食管癌根治术患者喉功能保留与发声重建的手术方法。方法：对16例下咽、颈段食管癌患者手术切除肿瘤后，实施保留全喉及部分喉切除喉功能重建；全喉切除后Blom-Singer 1期、2期发声重建术，同时下咽及颈段食管缺损分别采用胃－咽吻合、前臂游离皮瓣、胸大肌肌皮瓣、胸三角皮瓣、胸锁乳突肌肌皮瓣，颈前肌皮瓣、喉气管粘膜瓣等方法进行整复。保留全喉8例，保留部分喉喉重建3例，全喉切除后行Blom-Singer发声重建1期4例，2期1例。结果：16例中除1例术后14d心脏病变发死亡外，均恢复了吞咽功能，13例恢复发声功能，6例恢复了全喉功能，2例恢复了部分喉功能（不能拔管）。5例行Blom-Singer发声重建者，均发声成功。结论：依据患者病变部位、肿瘤分期、身体状况、年龄等因素，切除肿瘤后采用不同的手术方法行喉功能保留及发声重建，可提高患者术后生存质量。

Laryngeal function preservation and voice reconstruction in surgical treatment of hypopharyngeal and cervical esophageal carcinoma

Objective:To evaluate surgical treatment methods for preserving laryngeal function and voice reconstruction for patients with hypopharyngeal and cervical esophageal carcinoma.Method:16 patients with hypopharyngeal and cervical esophageal carcinoma were treated with preserving laryngx in 8 cases, partial laryngectomy with laryngeal reconstruction in 3,voice reconstruction by blom-singer technique without laryngeal function preservation in 5.The types of hypopharyngeal and cervical esophageal reconstruction included gastrica transpostion, pectoralis major myocutaneous flap, free forearm flap, delto-pectoral skin flap, sternocleidomastoid myocutaneous flap, platysma smyocutaneous flap and laryngeal-tracheal flap following carcinoma resection.Result:Deglutition restored in all patients except one who died of heat-break in 14th day after the operation. 13 patients rehabilitated speech, total laryngeal function restoration in 6 cases, partial laryngeal function restoration in 2 cases. The overall following-up was from 2 to 5 years.For the 5 cases with blom-singer voice reconstruction, all of them restored speech function.Conclusion:To improve life quality, laryngeal function preservation and voice reconstruction should be done for patients with hypopharyngeal and cervical esophageal carcinoma. Surgery methods should be carefully selected according to tumor's site, staging, patient's general condition and age.