晚期下咽癌、喉復(fù)發(fā)癌術(shù)后頸部缺損整復(fù)組織的選擇

1、晚期下咽癌、喉復(fù)發(fā)癌術(shù)后頸部缺損整復(fù)組織的選擇         08-03-22 11:59:00     作者：董頻    編輯：studa20【摘要】  目的 探討以不同組織移植物期重建晚期下咽癌、喉復(fù)發(fā)癌術(shù)后頸部、下咽食管缺損的適應(yīng)證及治療效果。方法 喉復(fù)發(fā)癌36例, 腫瘤切除后采用胸大肌肌皮瓣修補(bǔ)組織缺損18例，肩胸皮瓣修補(bǔ)4例，胃代食管修補(bǔ)2例，胸部推移皮瓣重建下頸部與上縱隔組織缺損，并消滅手術(shù)死腔12例。晚期下咽癌

2、16例,頸段食管癌8例，以游離空腸整復(fù)1例, 健側(cè)喉黏膜瓣修復(fù)咽部缺損8例，喉氣管代食道8例，胸大肌皮瓣修復(fù)咽部缺損2例，胃代食管2例，游離前臂皮瓣修復(fù)下咽1例。 結(jié)果 術(shù)中無(wú)一例死亡，術(shù)后無(wú)修復(fù)組織壞死 ,全部組織瓣存活。采用健側(cè)喉黏膜瓣修復(fù)者，僅 1例有術(shù)前放療史的患者發(fā)生術(shù)后咽漏，胸大肌皮瓣修復(fù)者發(fā)生咽漏1例，胃代食道術(shù)后發(fā)生咽漏1例。全部病例愈合后均恢復(fù)正常飲食。隨訪 9 84個(gè)月，14例出現(xiàn)吞咽梗阻，可進(jìn)流質(zhì)飲食。結(jié)論 下咽癌患者術(shù)后組織缺損的修復(fù)方法各有側(cè)重。腫瘤的部位和手術(shù)后組織缺損的大小是選擇修復(fù)方法的首要因素；其次，應(yīng)結(jié)合患者的年齡和全身狀況，考慮減少并發(fā)癥。 【關(guān)鍵詞】&#

3、160; 下咽腫瘤 喉腫瘤 頸部重建    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  資料與方法    1.1  臨床資料  1995年1月至2007年1月間在我科接受手術(shù)治療的喉復(fù)發(fā)癌和晚期下咽癌患者60例,男58例,女2例，40 78歲,平均64歲。喉復(fù)發(fā)癌36例， 晚期下咽癌16例，頸段食管癌8例。    1.2  方法  根據(jù)病史和CT（或MRI）、纖維氣管鏡、食管鋇餐透視等確定病變范圍與

10、部位，在排除縱隔及肺轉(zhuǎn)移后，對(duì)腫瘤施行根治性手術(shù)，有頸部淋巴結(jié)轉(zhuǎn)移者同時(shí)行頸廓清術(shù)。喉復(fù)發(fā)癌整復(fù)方法：造瘺口型者6例行造瘺口復(fù)發(fā)癌切除，氣管向下切除到第5 8氣管環(huán)，胸部推移皮瓣修補(bǔ)；復(fù)發(fā)癌、型者15例行根治性頸廓清，造瘺口復(fù)發(fā)癌切除上縱隔部分廓清，術(shù)中探明腫瘤界限后自上而下沿氣管環(huán)切除腫瘤，切除胸骨柄上段和鎖骨頭，廓清氣管旁及上縱隔淋巴結(jié)。部分喉切除術(shù)后復(fù)發(fā)者行擴(kuò)大的全喉切除術(shù)。切除后缺損采用胸大肌肌皮瓣修補(bǔ)18例，切取皮瓣或肌皮瓣為4?cm×5?cm 10?cm×12?cm，肩胸皮瓣修補(bǔ)4例，胃代食管修補(bǔ)2例，胸部推移皮瓣重建下頸部與上縱隔缺損并消滅手術(shù)死腔12例。&#

11、160;   晚期下咽癌及頸段食管癌整復(fù)方法：行腫瘤切除術(shù)后，組織缺損以游離空腸整復(fù)1例, 空腸瓣長(zhǎng)15?cm, 用健側(cè)喉黏膜瓣修復(fù)部分咽部缺損8例，喉氣管代食道8例，胸大肌肌皮瓣修復(fù)咽部缺損2例，胃代食管4例，游離前臂皮瓣修復(fù)下咽1例。    2  結(jié)  果    術(shù)中無(wú)一例死亡，術(shù)后無(wú)修復(fù)組織壞死 ,全部組織瓣存活。全部病例愈合后均可正常飲食。隨訪 9 84個(gè)月，1年累積生存率42.63，3年累積生存率11.66%。14例出現(xiàn)吞咽梗阻，可進(jìn)流質(zhì)飲食。并發(fā)癥共16例，采用健側(cè)喉黏膜瓣修復(fù)者,僅 1例有術(shù)前放療史的患者發(fā)生術(shù)后咽漏；胸大肌肌皮瓣修復(fù)者發(fā)生咽漏1例，胃代術(shù)后發(fā)生咽漏1例。其余為傷口感染4例、皮膚裂開(kāi)1例、造瘺口感染2例、肺炎6例等。    3  討  論    能利用自身喉瓣修復(fù)咽、氣管的患者，一般均可行喉功能保全手術(shù)，但對(duì)伴有心肝肺等全