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目的探讨管状成形胃一期修复下咽癌合并喉侵犯术后缺损的临床应用。方法回顾分析2000年以来32例下咽癌合并喉侵犯患者,行喉、咽切除,食管拔脱,胃-口咽吻合手术,其中11例采用全胃重建,21例采用管状成形胃重建。结果无围手术期死亡。吻合口瘘3例,均为全胃重建术式;心律失常12例;肺部感染20例;血胸1例。后期吻合口狭窄6例,均采用内镜扩张处理。采用管状成形胃重建的患者均呼吸功能良好,无胸闷气急,6例轻度夜间反流,采用药物控制。结论胃代食管重建消化道治疗下咽癌合并喉侵犯具有良好的一期修复效果,特别是采用管状成形胃重建能有效减少术后并发症,提高患者生活质量。
Objective To investigate the clinical application of tubular form stomach repair of hypopharyngeal carcinoma combined with laryngeal invasion. Methods Thirty-two patients with hypopharyngeal carcinoma complicated with laryngeal invasion since 2000 were retrospectively analyzed. Throat, pharyngectomy, esophageal extraction and anastomosis of the oro-oro-pharyngeal were performed. Among them, 11 cases underwent total stomach reconstruction and 21 cases underwent tubular reconstruction. Results no perioperative deaths. Anastomotic fistula in 3 cases, all of the total stomach reconstruction; arrhythmia in 12 cases; pulmonary infection in 20 cases; hemothorax in 1 case. Late anastomotic stenosis in 6 cases, were treated with endoscopic dilatation. Patients who underwent tubular reconstruction had good respiratory function, no chest tightness and shortness of breath, and 6 had mild nighttime reflux using drug control. Conclusion Gastroesophageal reconstruction of the lower gastrointestinal tract with hypopharyngeal carcinoma combined with laryngeal invasion has a good first-phase repair effect, especially the use of tubular shaped reconstruction can effectively reduce the postoperative complications and improve the quality of life of patients.