保留喉功能的下咽癌手术方法及其疗效

目的探讨保全喉功能的下咽癌手术和缺损一期修复方法及其疗效。方法2000年5月~2007年3月收治下咽癌患者39例,其中梨状窝癌27例,环后区癌8例,后壁区癌4例。以简便易行且损伤小为原则,在肿瘤切除的同时分别应用局部缝合、舌骨下肌群皮瓣、胸大肌皮瓣、胃代食道等对缺损进行一期修复。结果胸舌骨肌肌筋膜瓣修补患侧喉梨状窝13例、咽后壁1例及咽舌根4例;环后、食道切除胃上提修复咽、食道7例;咽局部缝合5例;胸大肌皮瓣修补3例;替尔皮片修补4例,胸锁乳突肌皮瓣修补2例。患者在生存期内均获随访,约半数患者术后有轻度误咽,适应训练后好转;2例患者有误吸。所有患者喉功能均恢复,其中21例患者拔除套管后呼吸及发音功能正常,18例带套管呼吸。术后1a内死亡14例;术后存活>3a有13例,>5a有5例。颈部复发或颈淋巴转移再手术13例,最多手术次数6次;本组患者3a生存率43.3%(13/30),5a生存率37.5%(3/8)。结论根据下咽癌的不同部位和分期,选择保留喉功能的肿瘤切除术及咽、喉及颈段食管缺损的一期修复方法,可取得良好的功能恢复和预后。

Conservative surgery method of hypopharyngeal carcinoma

Objective To evaluate the feasibility of different kinds of surgeries to treat hypopharyngeal carcinoma and investigate the methods to conduct one-stage repair after hypopharyngeal carcinoma removal. Methods Thirty nine cases of hypopharyngeal carcinoma were treated from May 2000 to Mar 2007, of which 27 were originated from pyriform sinus, 8 from postcricoid and 4 from posterior pharyngeal wall. One-stage reconstruction for hypopharyngeal and esophageal defect was done with simple and less-damaged hypopharyngeal plasty by local sewing, infrahyoid muscle flap, pectoralis major flap and supplement of esophagus by stomach. Results The defect of 18 cases was repaired by sternohyoid muscle flap, including 13 from pyriform sinus, 4 from root of tongue and 1 from posterior pharyngeal wall. Seven were repaired by substitute of esophagus by stomach, 5 by local sewing, 4 by cervical flap and 2 by pectoralis major myocutaneous flap. All the patients were successfully followed up during the survival days. Half of the cases suffered from slight deglutitory disorder after operation and recovered soon, while 2 cases were still with worse deglutitory function. All the cases were recovered with laryngeal function, and 21 cases were decannulated with normal respiration and voice, and 18 with cannula. Thirteen cases survived for more than 3 years after operation and 5 cases more than 5 years, while 14 cases died within 1 year. Thirteen cases were carried out another operations for local recurrence or metastases of lymph nodes, one of whom experienced 6 operations. The estimated 3-year survival was 43.3% (13/30), and 5-year survival was 37.5%(3/8). Conclusion Hypopharyngeal carcinoma with different site and stage can be treated by different methods, and one-stage reconstruction can be done to repair the defect of pharynx and esophagus with satisfactory functional restoration and prognosis.