晚期下咽癌、喉复发癌术后颈部缺损整复组织的选择

1、晚期下咽癌、喉复发癌术后颈部缺损整复组织的选择         08-03-22 11:59:00     作者：董频    编辑：studa20【摘要】  目的 探讨以不同组织移植物期重建晚期下咽癌、喉复发癌术后颈部、下咽食管缺损的适应证及治疗效果。方法 喉复发癌36例, 肿瘤切除后采用胸大肌肌皮瓣修补组织缺损18例，肩胸皮瓣修补4例，胃代食管修补2例，胸部推移皮瓣重建下颈部与上纵隔组织缺损，并消灭手术死腔12例。晚期下咽癌

2、16例,颈段食管癌8例，以游离空肠整复1例, 健侧喉黏膜瓣修复咽部缺损8例，喉气管代食道8例，胸大肌皮瓣修复咽部缺损2例，胃代食管2例，游离前臂皮瓣修复下咽1例。 结果 术中无一例死亡，术后无修复组织坏死 ,全部组织瓣存活。采用健侧喉黏膜瓣修复者，仅 1例有术前放疗史的患者发生术后咽漏，胸大肌皮瓣修复者发生咽漏1例，胃代食道术后发生咽漏1例。全部病例愈合后均恢复正常饮食。随访 9 84个月，14例出现吞咽梗阻，可进流质饮食。结论 下咽癌患者术后组织缺损的修复方法各有侧重。肿瘤的部位和手术后组织缺损的大小是选择修复方法的首要因素；其次，应结合患者的年龄和全身状况，考虑减少并发症。 【关键词】&#

3、160; 下咽肿瘤 喉肿瘤 颈部重建    laryngeal recurrent carcinoma      Abstract: Objective   To explore how to repair the hypopharyngeal and cervical defects after carcinoma removal in patients with hypopharyneal carcinoma of the advanced stage and laryngeal recur

4、rent carcinoma. Method   36 cases of recurrent laryngeal carcinoma were treated. The defects of 18 cases were repaired with pectoralis major flaps, of 4 with deltopectoralis skin flaps, of 2 with stomach replaced esophagus and of 12 with the flap shift from thoraces to cover the dead space

5、. Also 16 cases of late hypopharyngeal and eight cases of cervical esophageal carcinoma were treated in this study. The defects of 1 case was repaired with jejunal interposition, of 8 with laryngeal mucosal flaps from the uninjured side, of 8 with laryngotracheal interpositions, of 2 with pectoralis

6、 major flaps, of 2 with stomach replaced esophagus, and of 1 with a free antebrachial flap. Results   No one died during thehappened after the  operations. All flaps survived. In cases repaired with laryngeal mucosal flaps, only 1 with preoperational radiotherapy suffered from pharyng

7、eal fistula. 1 case was repaired with a pectoralis major flap and 1 with a stomach replaced esophagus suffered from a pharyngeal fistula. All patients could intake semifluid after healing. Followed up for 9 to 84 months, 14 patients had dysphagia but still could intake semifluid. Conclusions &#

8、160; All kinds of ways to reconstruct the defect of hypopharynx are good in different aspects and have different indications. Location of the tumor and size of the defects are the most important factors for choosing the reconstruction method. Also, complications should be decreased.   

9、; Key words: Hypopharyngeal neoplasms； Laryngeal neoplasms； Neck  reconstruction1  资料与方法    1.1  临床资料  1995年1月至2007年1月间在我科接受手术治疗的喉复发癌和晚期下咽癌患者60例,男58例,女2例，40 78岁,平均64岁。喉复发癌36例， 晚期下咽癌16例，颈段食管癌8例。    1.2  方法  根据病史和CT（或MRI）、纤维气管镜、食管钡餐透视等确定病变范围与

10、部位，在排除纵隔及肺转移后，对肿瘤施行根治性手术，有颈部淋巴结转移者同时行颈廓清术。喉复发癌整复方法：造瘘口型者6例行造瘘口复发癌切除，气管向下切除到第5 8气管环，胸部推移皮瓣修补；复发癌、型者15例行根治性颈廓清，造瘘口复发癌切除上纵隔部分廓清，术中探明肿瘤界限后自上而下沿气管环切除肿瘤，切除胸骨柄上段和锁骨头，廓清气管旁及上纵隔淋巴结。部分喉切除术后复发者行扩大的全喉切除术。切除后缺损采用胸大肌肌皮瓣修补18例，切取皮瓣或肌皮瓣为4?cm×5?cm 10?cm×12?cm，肩胸皮瓣修补4例，胃代食管修补2例，胸部推移皮瓣重建下颈部与上纵隔缺损并消灭手术死腔12例。&#

11、160;   晚期下咽癌及颈段食管癌整复方法：行肿瘤切除术后，组织缺损以游离空肠整复1例, 空肠瓣长15?cm, 用健侧喉黏膜瓣修复部分咽部缺损8例，喉气管代食道8例，胸大肌肌皮瓣修复咽部缺损2例，胃代食管4例，游离前臂皮瓣修复下咽1例。    2  结  果    术中无一例死亡，术后无修复组织坏死 ,全部组织瓣存活。全部病例愈合后均可正常饮食。随访 9 84个月，1年累积生存率42.63，3年累积生存率11.66%。14例出现吞咽梗阻，可进流质饮食。并发症共16例，采用健侧喉黏膜瓣修复者,仅 1例有术前放疗史的患者发生术后咽漏；胸大肌肌皮瓣修复者发生咽漏1例，胃代术后发生咽漏1例。其余为伤口感染4例、皮肤裂开1例、造瘘口感染2例、肺炎6例等。    3  讨  论    能利用自身喉瓣修复咽、气管的患者，一般均可行喉功能保全手术，但对伴有心肝肺等全