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目的:探讨经口内镜微创手术治疗环后区和食管入口病变的疗效。方法:经口内镜微创手术治疗环后区和食管入口病变患者15例。15例中,原发于下咽环后区肿瘤类病变7例,其中浅表的环后区鳞状细胞癌3例(AJCC TNM分期:T2N0M02例,T2N2cM01例),海绵状血管瘤2例,颈部手术切开后复发的多发纤维脂肪瘤1例,巨大纤维血管性息肉1例;食管入口区病变8例(Zenker憩室1例,脑卒中后环咽肌失弛缓引发吞咽障碍、经康复治疗失败7例)。3例环后癌均术后辅助放疗。1例T2N2cM0患者同期行双侧颈淋巴结清扫。结果:7例环后区肿瘤类病变均完整切除。3例环后癌和良性肿瘤外科切缘阴性,2例环后癌随访16~30个月和4例良性肿瘤随访2~12个月,局部无复发。近期完成手术的1例环后癌患者仍在术后放疗中。7例吞咽障碍患者4例摆脱鼻饲。1例Zenker憩室症状消失,吞咽造影复查正常。所有患者均未行气管切开术,术后第2~3天可以经口进流食或稀半流食。住院时间明显缩短,术后并发症轻微。结论:经口内镜微创手术能治疗一些环后区和食管入口病变。选择合适病例效果良好,并发症轻微,避免了传统开放手术的创伤。
Objective: To investigate the efficacy of endoscopic minimally invasive surgery in the treatment of posterior annular region and esophageal lesions. Methods: Minimally invasive endoscopic surgery for the treatment of posterior annular area and esophageal lesions in 15 patients. Of the 15 cases, 7 were tumorous lesions in the posterior region of the hypopharyngeal ring, including 3 cases of superficial posterior ring squamous cell carcinoma (AJCC TNM staging: T2N0M02 cases and T2N2cM01 cases), cavernous hemangioma in 2 cases, 1 case of multiple fibro-lipoma recurrence after neck surgery, 1 case of giant fibrovascular polyp; 8 cases of esophageal lesions (Zenker diverticulum, 1 case of dysphagia of cricopharyngeal muscle after stroke), after rehabilitation treatment Failure in 7 cases). Three cases of postoperative cancer were adjuvant radiotherapy. One case of T2N2cM0 patients underwent bilateral cervical lymph node dissection in the same period. Results: All 7 cases of posterior circumfluence tumors were completely resected. 3 cases of posterior ring cancer and benign tumor were negative for surgical margin, 2 cases of posterior ring cancer were followed up for 16 to 30 months and 4 cases of benign tumor were followed up for 2 to 12 months without local recurrence. One case of post-cancerous patients who have recently undergone surgery is still undergoing postoperative radiotherapy. Four patients with swallowing disorder got rid of nasal feeding in seven cases. One case of Zenker diverticulum symptoms disappeared, swallowing angiography review normal. All patients were not tracheotomy, after 2 to 3 days can be fed into the mouth or dilute semi-liquid diet. Significantly shorter hospital stay, minor postoperative complications. Conclusions: Minimal invasive endoscopic surgery can treat some of the posterior circumforamen and esophageal lesions. Select the appropriate case of good results, minor complications, to avoid the trauma of the traditional open surgery.