摘要
目的 探讨下咽癌的外科治疗及术后下咽食管缺损不同组织移植Ⅰ期重建方法在下咽癌治疗中的远期疗效。方法 回顾性分析 196 5～ 1998年外科治疗下咽癌患者 30 3例 ,其中 130例经不同组织移植重建下咽食管手术治疗 (1997年UICC分期 :Ⅱ期 5例 ;Ⅲ期 16例 ;Ⅳ期 10 9例 ) ,其中梨状窝区 94例 ,咽后壁区 18例 ,环后区 18例。游离空肠 15例 ,胃代下咽食管 81例 ,结肠代下咽食管 10例 ,胸大肌肌皮瓣修复 2 0例 ,其他方法 4例。 173例下咽癌患者不需要重建 (Ⅰ期 7例 ,Ⅱ期 12例 ,Ⅲ期 5 1例 ,Ⅳ期 10 3例 ) ,其中梨状窝 16 0例 ,咽后壁 8例 ,环后 5例。结果 Kaplan Meire法统计生存率 ,130例组织移植重建患者 3年生存率为 4 3 2 % ,5年生存率为 36 4 % ;173例不需要组织重建患者 3年生存率为 5 9 2 % ,5年生存率为 4 7 7%。各组吞咽功能良好率均在 80 %以上。胃代下咽食管手术死亡率为 8 6 % (7/81例 ) ;胸大肌肌皮瓣修复手术死亡率 15 0 % (3/2 0 9例 ) ;游离空肠及结肠代食管下咽无手术死亡。总手术并发症 2 0世纪 90年代之前为 4 4 3% (35 /79例 ) ,90年代手术并发症为 13 7%(7/5 1例 ) ,χ2 =13 4 5 7,P =0 0 0 4 ,差异有显著性 ;其中 90年代胸大肌肌皮瓣修复并发症最高为18 2 % (2 /11例 )。结论?
Objective To study the surgical treatment and the long term effect of different reconstructive methods in surgical treatment of hypopharyngeal cancer Methods A retrospective review of 303(265 males,38 females,ages rranging from 32 to 77 years)cases with hypopharyngeal cancer that were treated with surgical treatment from 1965 to 1998 were accomplished Of the 303 cases,130 cases were treated with different reconstructive methods and 173 cases without reconstruction Of the 130(stageⅡ,5;Ⅲ,16;Ⅳ,109)cases, 94 were originated from pyriform sinus,18 from posterior pharyngeal wall and 18 from postcricoid Fifteen patients were reconstructed with free jejunum Eighty one patients were performed total pharyngo larygo oesophagectomy and gastric pull up Ten patients were treated with vascularized colon Twenty patients were reconstructed with pectorals major myocutaneous flap Four patients were reconstructed with other methods Of the 173(stageⅠ,7;Ⅱ,12;Ⅲ,51;Ⅳ,103)cases, 160 were originated from pyriform sinus,8 from posterior pharyngeal wall and 5 from postcricoid Results The overall 3 and 5 years survival rate of 130 patients with reconstruction were 43 2%,36 4% respectively The overall 5 years survival rate of 173 patients with no reconstruction was 47 7% The overall rate of regular swallowing was over 80% The mortality rate in period of surgery of gastric pull up and pectorals major myocutaneous flap were 8 6% and 15% respectively No patients with free jejunum and vascularized colon died The overall complication rate in nineties was lower than before 1990 (χ 2=13 457, P =0 004) The highest complication rate occurred in patients with pect0rals major myocutaneous flap In contrast to other reconstruction methods, the rate of success of swallowing was higher in patients with free jejunum Conclusions In selected patients these reconstruction techniques enable functional rehabilitation of swallowing Even high survival rate was obtained after extended partial pharyngolaryngectomy
出处
《中华耳鼻咽喉科杂志》
CSCD
北大核心
2004年第3期166-170,共5页
Chinese Journal of Otorhinolaryngology
关键词
下咽癌
外科治疗
组织移植修复重建术
下咽食管缺损
Hypopharyngeal neoplasms
Transplants
Survival rate
Intraoperative complications
Postoperative complications
