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目的探讨不同手术方法修复重建下咽颈食管环周缺损的适应证,对不同方法的优缺点进行比较。方法对1993年6月至2006年6月期间收治的72例下咽颈食管区肿瘤进行手术切除,并根据肿瘤切除术后缺损的范嗣,采用胸大肌肌皮瓣、喉管、游离空肠、游离前臂皮瓣和胃上提咽胃吻合5种方法对肿瘤切除术后所致的下咽颈食管环周缺损进行一期修复重建,并重点对所有患者术后的吞咽功能恢复情况进行观察和客观评估。结果胸大肌肌皮瓣修复重建31例,喉管代下咽颈食管8例,游离空肠移植12例,游离前臂皮瓣移植4例,胃上提咽胃吻合术17例。其中15例患者出现了不同程度的并发症,包括创口感染、咽漏、皮瓣部分坏死、胃壁部分坏死和食管吻合口狭窄等,除1例死亡外,其他患者经处理全部治愈。本组患者术后吞咽功能恢复满意,除2例食管吻合口狭窄患者可以进半流食外,其余患者均恢复了正常的进食功能。平均随访时间为1.6年,术后2年生存率为45.3%。结论下咽颈段食管癌切除术后所致的环周缺损可依据缺损的范围和患者的情况选择不同的修复方法,只要适应证掌握得当均可获得满意的修复重建效果。
Objective To explore the indications of reconstructive hypopharyngeal esophageal neoplasms by different surgical methods and to compare the advantages and disadvantages of different methods. Methods Seventy - two cases of hypopharyngeal esophageal tumors were treated by surgical resection between June 1993 and June 2006. According to Fan Si, who underwent resection of tumor after resection of the tumor, the pectoralis major myocutaneous flap, the larynx, the free jejunum , Free forearm flap and stomach to pharyngeal anastomosis 5 methods of tumor resection after hypopharyngeal esophageal perineal defect repair and reconstruction of a focus on all patients after swallowing recovery was observed And objective assessment. Results Pectoralis major myocutaneous flap repair and reconstruction in 31 cases, throat hypopharyngeal esophagus in 8 cases, free jejunal transplantation in 12 cases, free forearm flap transplantation in 4 cases, 17 cases of stomach to mention pharyngeal anastomosis. Among them, 15 patients had different degrees of complications, including wound infection, pharyngeal leakage, partial necrosis of the flap, partial necrosis of the stomach wall and esophageal anastomotic stenosis. All patients were cured except one patient died. The patients with postoperative swallowing functional recovery satisfaction, except for 2 cases of esophageal anastomotic stenosis can enter the semi-liquid food, the rest of the patients were restored to normal eating function. The average follow-up time was 1.6 years, and the 2-year survival rate was 45.3%. Conclusions The peri-pharyngeal defect after esophageal cancer resection can select different repair methods according to the scope of the defect and the patient’s condition. Satisfactory repair and reconstruction results can be obtained as long as the indications are properly grasped.