下咽及颈段食管缺损修复的供区选择和临床评价

陈文和; 彭汉伟

doi:10.13201/j.issn.1001-1781.2013.21.001

下咽及颈段食管缺损修复的供区选择和临床评价

陈文和¹,
彭汉伟^2, ,

- 1 潮州市潮州医院胸部/头颈外科(广东潮州, 521011);
- 2 汕头大学医学院附属肿瘤医院头颈科

详细信息

通讯作者: 彭汉伟,E-mail:penghanwei@126.com

中图分类号: R473.73

收稿日期: 2013-01-08

Reconstruction for the defects of hypopharynx and cervical esophagus:donor site selection and clinical evaluation

CHEN Wenhe¹,
PENG Hanwei^2, ,

- 1 Department of Thoracic Head and Neck Surgery, Chaozhou People's Hospital, Chaozhou, 521011, China;
- 2 Department of Head and Neck Surgery, Cancer Hospital of Shantou University Medical College

More Information

Corresponding author: PENG Hanwei, E-mail: penghanwei@126.com

Received Date: 08 January 2013

摘要

摘要: 目的:探索下咽及颈段食管缺损的分类及不同类型缺损的修复方法选择原则和临床疗效。方法:2007-01-2012-06期间共行下咽及颈段食管缺损修复术39例。根据下咽及颈段食管缺损程度分为环周/近环周缺损组(A组,23例)和部分缺损组(B组,16例);根据颈部血管状况分为颈部血管状况不良组(22例)和颈部血管状况良好组(17例)。供区选择主要根据缺损程度和颈部血管状况决定。A组采用股前外侧皮瓣8例、胃上提6例、桡侧前臂皮瓣3例、空肠瓣和胸大肌肌皮瓣各3例;B组采用舌骨下肌肌皮瓣8例、桡侧前臂皮瓣 3例、胸大肌肌皮瓣5例。观察皮瓣的存活率、手术并发症、功能效果和肿瘤治疗的临床转归。结果:全组并发症发生率为12.8%(5/39)。A组空肠瓣、股前外侧皮瓣、胸大肌肌皮瓣坏死各1例,皮瓣坏死均发生在颈部血管状况不良组;B组发生咽瘘1例,无皮瓣坏死。全组2例未能经口进食,其余病例无进食障碍;保留喉功能16例均发音良好。全组2年、3年总生存率分别为72.1%和65.2%。结论:下咽及颈段食管缺损修复供区的选择应根据缺损程度、颈部血管状况和组织瓣的特性综合分析,个体化应用。个体化下咽及颈段食管修复可获得满意的临床疗效。
- 下咽及颈段食管 /
- 外科皮瓣 /
- 股前外侧皮瓣 /
- 桡侧前臂皮瓣 /
- 胸大肌肌皮瓣 /
- 舌骨下肌肌皮瓣
Abstract: Objective: To explore the principles of donor site selection for defects of the hypopharynx and/or cervical-esophagus based on a novel defect classification system and treatment outcome of this series.Method: Thirty-nine patients underwent reconstruction of their defects of the hypopharynx and/or cervical-esophagus from January 2007 to June 2012 were retrospectively studied. 23 hypopharngeal and/or cervical-esophageal defects were circumferential or near circumferential(group A), 16 were partial(group B). 22 patients had compromised neck vascular status, while the other 17 patients had normal neck vascular status. Selection of the donor sites was based on extent of the defects and neck vascular status. Donor sites for reconstruction of the defects of group A included anterolateral thigh flap(n=8), gastric pull-up(n=6), radial forearm flap(n=3), jejunum flap(n=3), and pectoralis major myocutaneous flap(n=3). For goup B, Infrahyoid myocutaceous flaps, radial forearm flaps, and pectoralis major myocutaneous flaps were used in 8, 3, and 5 cases, respectively. Flap survival, surgical complications, function outcome, and tumor control were observed.Result: Overall complication rate was 12.8%(5/39) in this series. In group A, three flap necroses occurred in jejunum flap(n=1), anterolateral thigh flap(n=1), and pectoralis major flap(n=1). All these flap necroses occurred in the compromised neck vascular status group. One case of pharyngeal fistula without flap necrosis occurred in Group B. All except 2 patients restored oral intake postoperatively; 16 patients with laryngeal preservation had good phonation postoperatively. 2-year and 3-year survival of this series were 72.1% and 65.2%, respectively.Conclusion: Selection of an appropriate donor site for reconstruction of the defects of hypopharynx and /or cervical-esophagus should be based on the extent of the defects, neck vascular status, and clinical features of the flap. Individualized donor site selection for hypopharyngeal and cervical esophageal defects reconstruction can result in good clinical outcome.
- hypopharnx and cervical esophagus /
- surgical flap /
- anterolateral thigh flap /
- radial forearm flap /
- pectoralis myocutaneous flap /
- infrahyoid myocutaneous flap

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参考文献(19)

[1]	BRADLEY P T, BRADLEY P J. Treatment of hypopharyngeal carcinoma with primary chemoradiotherapy:functional morbidity[J]. Curr Opin Otolaryngol Head Neck Surg, 2012,20:89-96.
[2]	LAM K H, HO C M, LAU W F, et al. Immediate reconstruction of pharyngoesophageal defects. Preference or reference[J]. Arch Otolaryngol Head Neck Surg, 1989,115:608-612.
[3]	CHU P Y, CHANG S Y. Reconstruction of the hypopharynx after surgical treatment of squamous cell carcinoma[J]. J Chin Med Assoc, 2009,72:351-355.
[4]	唐平章, 祁永发, 吴雪溪, 等. 303例下咽癌的外科治疗及组织移植修复重建术的临床分析[J]. 中华耳鼻咽喉科杂志,2004,39(1):41-45.
[5]	LEWIN J S, BARRINGER D A, MAY A H, et al. Functional outcomes after laryngopharyngectomy with anterolateral thigh flap reconstruction[J]. Head Neck, 2006,28:142-149.
[6]	胡敏霞, 宋声达. 下咽癌手术中胃上提术30年应用变迁[J]. 国外医学.耳鼻咽喉科学分册, 2000,24(4):253-254.
[7]	DISA J J, PUSIC A L, MEHRARA B J. Reconstruction of the hypopharynx with the free jejunum transfer[J]. J Surg Oncol, 2006,94:466-470.
[8]	李浩, 伍国号, 刘均墀, 等. 应用股前外侧皮瓣修复头颈肿瘤手术后缺损[J]. 中华显微外科杂志,2006, 29(2):146-147.
[9]	彭汉伟, 杨熙鸿, 郭海鹏, 等. 桡侧前臂皮瓣和舌骨下肌肌皮瓣在半舌缺损修复中的比较[J]. 实用癌症杂志, 2011,26(6):603-605.
[10]	彭汉伟, 曾宗渊, 杨安奎, 等. 舌骨下肌皮瓣在头颈肿瘤切除术后缺损修复中的应用[J]. 中华显微外科杂志, 2006,29(4):312-313.
[11]	PENG H, WANG S J, YANG X, et al. Infrahyoid myocutaneous flap for medium-sized head and neck defects:surgical outcome and technique modification[J]. Otolaryngol Head Neck Surg, 2013,138:47-53.
[12]	杨熙鸿, 彭汉伟, 郭海鹏, 等. 组织瓣移植修复头颈癌术后缺损[J]. 中国修复重建外科杂志, 2007,21(4):430-432.
[13]	CLARK J R, MCCLUSKEY S A, HALL F, et al. Predictors of morbidity following free flap reconstruction for cancer of the head and neck[J]. Head Neck, 2007,29:1090-1101.
[14]	KRUSE A L, LUEBBERS H T, GRATZ K W, et al. Factors influencing survival of free-flap in reconstruction for cancer of the head and neck:a literature review[J]. Microsurgery, 2010,30:242-248.
[15]	彭汉伟, 郭海鹏, 刘木元,等. FOCUS超声刀和传统手术在胸大肌肌皮瓣制备中的比较及临床价值[J]. 中国肿瘤外科杂志, 2012,4(2):81-84.
[16]	KEKATPURE V D, TRIVEDI N P, MANJULA B V, et al. Pectoralis major flap for head and neck reconstruction in era of free flaps[J]. Int J Oral Maxillofac Surg, 2012,41:453-457.
[17]	XIAO Q, HU G H, ZHONG S X, et al. Reconstruction of hypopharynx and cervical oesophagus for treatment of advanced hypopharyngeal carcinoma and recurrent laryngeal carcinoma[J]. Asian J Surg, 2010,33:14-19.
[18]	周梁, 陶磊. 喉癌及下咽癌手术治疗进展[J]. 临床耳鼻咽喉头颈外科杂志, 2007,21(14):625-629.
[19]	李学忠, 张立强, 潘新良,等. 保留喉功能的下咽后壁癌的手术治疗[J]. 临床耳鼻咽喉科杂志,2005,19(17):1109-1115.