下咽及颈段食管癌的手术治疗

目的：探讨下咽及颈段食管癌的手术疗效及颈段食管重建的方法，方法：1980年至2000年6月对86例下咽及颈段食管鳞状细胞癌进行了外科治疗，下咽癌的切除率为97．4％（37／38例），食管重建包括喉及肿瘤切除后食管与口底吻合4例，咽，喉及颈段食管切除后用颈阔肌皮瓣重建15例，游离空肠间插3例，全咽，全喉，全食管切除后用胃重建12例，3例未行喉切除者采用食管与咽部直接吻合，颈阔肌皮瓣及用胃重建食管各1例，颈段食管癌的切除率为91．7％（44／48例），均采用非开胸食管拔脱后用胃重建食管，结果：术后发生并发症在胃重建组有57例（35％），（包括1例术后死于心力衰竭），游离空肠组1例（33．3％），颈阔肌皮瓣重建组3例（18．8％），随访6－108个月（平均57个月），下咽癌的1，3，5年生存率分别为80．6％，60．0％和31．6％，颈段食管癌分别为70．7％，9．5％和0。结论：下咽及颈段食管癌的切除率甚高，但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。

Surgical treatment of hypopharyngeal and cervical esophageal carcinoma

Objective: To evaluate the long term results of surgical treatment and the reconstructive methods of the cervical esophageal defect in patients with hypopharyngeal and cervical esophageal carcinoma. Methods: Eighty six patients with squamous cell carcinoma of the hypopharynx and cervical esophagus were operated in our department from 1980 to 2000. The resectability rate of hypopharyngeal carcinoma(HPC) was 97%(37/38). The esophageal reconstructions included oral floor and esophageal anastomosis after resection of pharynx and tumor in 4 cases, platysmamyocutaneous flaps reconstraction (PMFR) in 15, free jejunal interpostion after resection of laryngopharyngeal and cervical esophagus in 3, gastric pull up transposition following total pharyhngolaryngo esophagectomy in 12, pharyngo esophageal anastomosis without laryngectomy in 3, and PMFR and gastric pull up transposition in 1. The resectability rate of cervical esophageal carcinoma (CEC) was 91 6%(44/48). The method of the esophageal reconstruction was gastric pull up after esophagectomy without thoracotomy except one. Results: The postoperative morbidity was 35% for gastric pull up reconstruction, 33 3%(1/3) in free jejunal interposition and 18 8% in PMFR. The overall follow up was from 6 to 108 months (mean: 57 months) and the 1 , 3 , 5 year survival rates were 81 0%, 58 6% and 33 3% for HPC and 72 0%, 13 6% and 0 for CEC, respectively. Conclusion: Resectability rate of the HPC and CEC was quite high, but the long term result with CEC was poor and there was no 5 year survivor in this group. The PMFR after pharyngolaryngo cercival esophagectomy is a safe and effective way with low morbidity and excellent long term result.