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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 2 0 0 0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% (4 4/4 8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 5 7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～ 10 8个月 (平均 5 7个月 ) ,下咽癌的 1、3、5年生存率分别为 80 6 %、6 0 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
Objective To investigate the surgical treatment of hypopharynx and cervical esophageal carcinoma and the method of cervical esophageal reconstruction. Methods From 1980 to June 2000, 86 cases of pharyngeal and cervical esophageal squamous cell carcinoma were treated surgically. The resection rate of hypopharyngeal carcinoma was 97 4% (37/38 cases). Esophageal reconstruction included an esophageal and alveolar bottom anastomosis in 4 cases after resection of the larynx and tumor, reconstruction of the pharynx, larynx, and cervical esophagectomy using a platysma myocutaneous flap 15 Cases, free jejunostomy in 3 cases, total resection of the pharynx, total laryngectomy, total esophagectomy, reconstruction of 12 cases with gastrectomy, 3 cases without laryngectomy, direct esophageal and pharyngeal anastomosis, platysma myocutaneous flap and reconstruction of esophagus with stomach One case each. The resection rate of cervical esophageal cancer was 91 7% (44/48). Both of them were reattached using a non-opening esophagus and reconstructed with the stomach. Results Postoperative complications occurred in 57 (35.5%) patients in the gastric remodeling group (including 1 patient died of heart failure after operation), 1 patient (33. 3%) in the free jejunum group, and 3 patients with platysma myocutaneous flap reconstruction group. (18 8%). During follow-up of 6 to 10 8 months (mean, 5 7 months), the 1-, 3-, and 5-year survival rates of hypopharyngeal cancer were 80.6%, 60%, and 316%, respectively, and cervical esophageal cancer was 70. %, 95%, and 0. Conclusion The resection rate of hypopharyngeal and cervical esophageal cancer is very high, but the long-term efficacy of hypopharyngeal carcinoma is significantly better than that of cervical esophageal cancer. It is safe to use platysma myocutaneous flap reconstruction after esophagectomy of pharynx, larynx and neck. , Effective surgical methods, less complications, excellent long-term results