下咽及颈段食管癌手术方法的选择与探讨

目的:探讨下咽及颈段食管癌手术方法的选择与临床效果。方法:分析1995年以来68例下咽及颈段食管癌的手术治疗,其中位于下咽者27例,颈段食管者41例。结果:下咽癌切除26例,切除率为96.3%,手术中重建食管包括口底-食管吻合2例;咽、喉及颈段食管切除后用颈阔肌皮瓣重建11例、游离空肠代食管3例,全咽、全喉、全食管切除后用胃重建10例;颈段食管癌切除38例,切除率92.7%,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47例为27.7%(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9.1%。随访2~96个月(平均45.5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手术切除率高,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。

Selection and Investigation of Operational Methods on Hypopharngeal and Cervical Esophageal Carcinoma

Objective:To investigate the replantation Methods and treatment outcome of of hypopharyngeal and cervical esophageal carcinoma.Methods: Sixty-eight patients with squamous-cell carcinoma of the hypopharynx and cervical esophagus underwent operation surgery in our department from 1995 to June 2006.The site of the tumour was in hypopharynx in 27 patients and in cervical esophagus in 41.Results: The resectability rate of hypopharyngeal carcinoma(HPC) was 96.3%(26/27).The types of the esophageal reconstruction included pharyngo-esophageal anastomosis(3 patients) platysmamyocutaneous flaps reconstruction(PMFR)(11 patients) free jejunal interposition(3 patients) and gastric tube transposition following total pharyngolaryngo esophagectomy(10).The resectability rate of cervical esophageal carcinoma(CEC) was 92.7%(38/41).The esophageal construction applied gastric tube after esophagectomy without thoracotomy except one.The postoperative morbidity was 27.7% for gastric tube reconstruction(including one died of heart failure),33.3%(1/3) for free jejunal interposition and 9.1% for PMFR.The overall follow-up was from 2 to 96 months(median:45.5 months) and the 1-,3-,5-year survival rates were 76.9%,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.