摘要
目的探讨喉气管组织瓣在喉咽癌累及颈段食管手术后组织缺损修复中的应用价值。方法回顾分析术者近5年利用喉气管组织瓣修复15例喉咽癌累及颈段食管术后组织缺损的临床资料,其中喉气管组织瓣合并单侧双蒂带状肌瓣修复10例、喉气管组织瓣加单侧双蒂带状肌瓣加椎前筋膜修复3例、喉气管组织瓣加单侧双蒂带状肌瓣加胸大肌肌皮瓣修复2例。上述病例中,喉咽缺损修复后用胸锁乳突肌加固4例。结果术后喉气管瓣及修复组织瓣无坏死。5例术后并发小咽瘘。1例术后8个月发现舌根复发,再次手术,13个月后死亡;1例术后18个月死于局部复发;1例术后13个月发现对侧II区转移,再次手术,健在;1例术后11个月肺转移,化疗,健在;1例术后36个月,发现气管造口后复发,再次放疗后仍健在。12例术后16天内恢复了吞咽功能,其中10例同时恢复较好的发音功能;5例咽瘘皆在1个月内愈合并恢复了吞咽功能。经随访3、5年生存率分别为61.5%、37.5%。结论喉咽癌累及颈段食管手术后组织缺损有选择性应用喉气管复合组织瓣修复,手术创伤小、并发症少、术后发音恢复快、质量好,是一种比较理想的修复手段。
OBJECTIVE To evaluate the value of the laryngotracheal tissue flap in the reconstruction of postoperative defect of the hypopharynx carcinoma involving cervical esophagus. METHODS A retrospective study of 15 cases with postoperative defect of the hypopharynx carcinoma involving cervical esophagus which was reconstructed using the laryngotracheal tissue flap was carried out. The defects were reconstructed with laryngotracheal tissue flap and unilateral bipedicle muscular flap simultaneously in 10 cases,with laryngotracheal tissue flap, unilateral bipedicle muscular flap and prevertebral fascia in 3 cases, with laryngotracheal tissue flap, unilateral bipedicle muscular flap and pectoralis major myocutaneous flaps in 2 cases. Four cases reinforced the defects with the sternocleidomastoid muscle. RESULTS No necrosis of the flaps were found after reconstruction. Five cases healed with complication of small pharyngeal fistula. One case recurred in the base of tongue 8 months after operation, and died 13 months after reoperation. One case died of local recurrence 18 months after operation. One case was found contralateral cervical lymph node metastasis at level H and survived after operation. One case was found lung metastases, and received chemotherapy and survived. One case was found recurrence 36 months after operation, received radiotherapy and survived. Twelve cases recovered the function of deglutition at 16 days after operation, and among these 12 cases, 10 cases had good recovery of the voice function at the same time. Five cases which had complication of pharyngeal fistula healed in one month and their swallowing function recovered as well. According to the results of follow-up and by the Kaplan- Maier method, the 3-year and 5-year survival rates were 61.5% and 37.5% respectively. CONCLUSION The laryngotracheal tissue flap is a good option for the defect of the hypopharyngeal carcinoma involving the cervical esophagus. As a method of reconstruction, it was convenient, less damage and few complications.
出处
《中国耳鼻咽喉头颈外科》
北大核心
2009年第10期540-543,共4页
Chinese Archives of Otolaryngology-Head and Neck Surgery
关键词
下咽肿瘤
喉
气管
组织
外科皮瓣
修复外科手术
存活率
Hypopharyngeal Neoplasms
Larynx
Trachea
Tissues
Surgical Flap
Reconstructive Surgical Procedures
Survival Rate
