山东大学耳鼻喉眼学报

• 论文 •    下一篇

晚期下咽癌、喉复发癌术后颈部缺损整复组织的选择

董 频,李晓艳,屠理强,孟晴虹,王 桑,谢 晋,姜 彦   

  1. 上海交通大学附属第一人民医院耳鼻咽喉-头颈外科 上海交通大学医学院 耳鼻咽喉科研究所,上海 200080
  • 收稿日期:1900-01-01 修回日期:1900-01-01 出版日期:2007-10-24 发布日期:2007-10-24
  • 通讯作者: 董 频

Reconstruction for advanced hypopharyngeal carcinoma and laryngeal recurrent carcinoma

DONG Pin, LI Xiao-yan, TU Li-qiang, MENG Qing-hong, WANG Sang, XIE Jin, JIANG Yan   

  1. Department of Otolaryngology & Head and Neck Surgery, The First People′s Hospital affiliated to Shanghai Jiaotong University, Institute of Otorhinolaryngology of Shanghai Jiaotong University, Shanghai 200080
  • Received:1900-01-01 Revised:1900-01-01 Online:2007-10-24 Published:2007-10-24
  • Contact: DONG Pin

摘要: 目的:探讨以不同组织移植物Ⅰ期重建晚期下咽癌、喉复发癌术后颈部、下咽食管缺损的适应证及治疗效果。方法:喉复发癌36例, 肿瘤切除后采用胸大肌肌皮 瓣修补组织缺损18例,肩胸皮瓣修补4例,胃代食管修补2例,胸部推移皮瓣重建下颈部与上纵隔组织缺损,并消灭手术死腔12例。晚期下咽癌16例,颈段食管癌8例,以游离空肠整复1例, 健侧喉黏膜瓣修复咽部缺损8例,喉气管代食道8例,胸大肌皮瓣修复咽部缺损2例,胃代食管2例,游离前臂皮瓣修复下咽1例。 结果:术中无一例死亡,术后无修复组织坏死 ,全部组织瓣存活。采用健侧喉黏膜瓣修复者,仅 1例有术前放疗史的患者发生术后咽漏,胸大肌皮瓣 修复者发生咽漏1例,胃代食道术后发生咽漏1例。全部病例愈合后均恢复正常饮食。随访 9~84个月,14例出现吞咽梗阻,可进流质饮食。结论:下咽癌患者术后组织缺损的修复方法各有侧重。肿瘤的部位和手术后组织缺损的大小是选择修复方法的首要因素;其次,应结合患者的年龄和全身状况,考虑减少并发症。

关键词: 下咽肿瘤, 喉肿瘤, 颈部重建

Abstract: Objective:To explore how to repair the hypopharyngeal and cervical defects after carcinoma removal in patients with hypopharyneal carcinoma of the advanced stage and laryngeal recurrent carcinoma. Method:36 cases of recurrent laryngeal carcinoma were treated. The defects of 18 cases were repaired with pectoralis major flaps, of 4 with deltopectoralis skin flaps, of 2 with stomach replaced esophagus and of 12 with the flap shift from thoraces to cover the dead space. Also 16 cases of late hypopharyngeal and eight cases of cervical esophageal carcinoma were treated in this study. The defects of 1 case was repaired with jejunal interposition, of 8 with laryngeal mucosal flaps from the uninjured side, of 8 with laryngotracheal interpositions, of 2 with pectoralis major flaps, of 2 with stomach replaced esophagus,and of 1 with a free antebrachial flap.Results: No one died during the operations and no reconstructed tissue necrosis happened after the operations. All flaps survived. In cases repaired with laryngeal mucosal flaps, only 1 with pre-operational radiotherapy suffered from pharyngeal fistula. 1 case was repaired with a pectoralis major flap and 1 with a stomach replaced esophagus suffered from a pharyngeal fistula. All patients could intake semi-fluid after healing. Followed up for 9 to 84 months, 14 patients had dysphagia but still could intake semifluid. Conclusions:All kinds of ways to reconstruct the defect of hypopharynx are good in different aspects and have different indications. Location of the tumor and size of the defects are the most important factors for choosing the reconstruction method. Also, complications should be decreased.

Key words: Hypopharyngeal neoplasms, Laryngeal neoplasms, Neck reconstruction

中图分类号: 

  • R739.6
[1] 付玉贵,王海兰,孙德重,杨佩珍,陈彦林,陈志鹏. 保留部分环状软骨环的喉全切除术[J]. 山东大学耳鼻喉眼学报, 2017, 31(4): 73-75.
[2] 张明德,张祖平,于学民,魏燕红,袁英. RASSF2A基因甲基化在喉癌组织中的表达及意义[J]. 山东大学耳鼻喉眼学报, 2017, 31(4): 64-67.
[3] 马玲国,郑朝攀,周敬淳,张博,龚桃根,张云静. CO2激光治疗声门型喉癌远期疗效分析[J]. 山东大学耳鼻喉眼学报, 2016, 30(5): 98-100.
[4] 苏甜甜,张佳综述,孙臻峰审校. 多药耐药基因蛋白P-gp和ABCG2在喉癌等头颈肿瘤中的作用及相关信号通路[J]. 山东大学耳鼻喉眼学报, 2016, 30(3): 103-106.
[5] 钱小飞, 张速勤, 陈建良. 保留喉功能的梨状窝癌手术14例[J]. 山东大学耳鼻喉眼学报, 2015, 29(4): 35-37.
[6] 王守玺, 刘荷珍. 声门上水平喉部分切除术中舌骨去留对误咽的影响[J]. 山东大学耳鼻喉眼学报, 2015, 29(4): 45-47.
[7] 严羽, 朱江. 早期喉癌及喉癌前病变诊断的研究进展[J]. 山东大学耳鼻喉眼学报, 2015, 29(4): 80-85.
[8] 陈小玲, 费兵, 李贤斌, 吴昊. 靶向人喉癌HEP2细胞Trop2基因的siRNA构建及鉴定[J]. 山东大学耳鼻喉眼学报, 2015, 29(3): 51-53.
[9] 王玉红, 王倩, 陈萍, 钱晓云. 原发于喉部的非鳞状细胞癌11例并文献复习[J]. 山东大学耳鼻喉眼学报, 2015, 29(1): 83-88.
[10] 刘荷珍. 甲状软骨外膜和胸骨舌骨肌用于声门型喉癌切除喉重建临床分析[J]. 山东大学耳鼻喉眼学报, 2014, 28(4): 49-51.
[11] 田俊, 王丹丹, 皇甫辉, 王斌全, 李乐. 喉癌CT/MRI融合图像的建立及初步应用[J]. 山东大学耳鼻喉眼学报, 2014, 28(4): 52-55.
[12] 王英俊,孙彦,李薇,华辉,黄沂传,葛瑞锋,韩敏. 喉癌、喉咽癌手术相关肺血栓栓塞症的临床特点[J]. 山东大学耳鼻喉眼学报, 2014, 28(2): 51-54.
[13] 魏希建1,阴瑞兰2,郭星3. 增殖诱导配体在喉鳞状细胞癌中的表达[J]. 山东大学耳鼻喉眼学报, 2014, 28(1): 14-16.
[14] 刘昉1,赖建新1,李瑞玉1,李冠桢2. 喉癌患者外周血中Th17/Treg比率变化[J]. 山东大学耳鼻喉眼学报, 2013, 27(5): 4-7.
[15] 许莉,陈伟,季俊峰,许风雷,王秋萍. 达芬奇手术机器人辅助CO2激光切除下咽舌根肿瘤2例[J]. 山东大学耳鼻喉眼学报, 2013, 27(5): 1-3.
Viewed
Full text


Abstract

Cited

  Shared   
  Discussed   
No Suggested Reading articles found!