关键词: 喉功能重建手术, 下咽癌, 食管, 生存率

Abstract: Objective To explore the best treatment plan and treatment experience of the cervical esophagus invasion of cervical esophagus. Methods From2001 to 2012, seventy-one patients with advanced hypopharyngeal cancer and cervical esophageal invasion were retrospectively reviewed to summarize several safe and effective treatment methods, including 64 males and 7 females. The medianage was 56.8 years old, ranged from 36 to77 years old.According to AJCC 2002 criteria, all the tumors were T4 stage and originated from the pyriform sinus(51), posterior pharyngeal wall(18), post cricoid area(2), there were 44 patient sincN0, 4 in cN1, 20 in cN2, 3 in cN3 and no distant metastasis. Precise preoperative evaluation was performed with computed tomography scan, barium swallow perspective and biopsy. All the patients received neck dissection, including both unilateral(57 patients)and bilateral(14 patients). Pharyngoesophageal defect reconstruction methods were: pectoralis major musculocutaneous flap in 22 patients, laryngotracheal flap in 11,pectoralis major musculocutaneous flap combined with split thickness skin graft in 6, stomach pulling-up or coloninterpositionin in 31 patients. Total laryngectomy was carried out in 31 patients.65 patients received radio therapy postoperatively(dose55-70 Gy). Results The cervical lymph node metastasis rate was 45.1%.In 28 patients whose laryngeal function was preserved, the trachea cannula was extracted in 19 patients, with the decanulation rate as 67.8%. A total of 37 patients underwent thyroidectomy, 14 cases of postoperative patients with pathologically confirmed thyroid invasion. The common complications after surgery with pharyngeal fistula in 12 cases, 2 cases of incision infection, anastomotic stenosis in 1 cases. The 3 years and 5 years disease-free survival rate in all patients were 43.7% and 23.9% which calculated by Kaplan-Meier methods. The 3 years and 5 years disease-free survival rate of laryngeal function preservation group were 50% and 28.6%, while in non-functionally preserved group were 39.5% and 20.9%. There was no significantly different between the two groups(χ²=1.244,P=0.265). Conclusion Combined therapy 山东大学耳鼻喉眼学报30卷3期 -李文明,等.下咽癌侵犯颈段食管的治疗 \=-was the best choice for hypopharyngeal cancer with cervical esophageal invasion. The continuity of the pharyngoesophagus was restored by laryngotracheal flap, pectoralis major muculocutaneous flap or with split thickness skin graft. Stomach trans-position or colon interposition was used while the defect of the esophagus was greater.All of those operation methods were safe and effective. Some patients with appropriate surgical procedures can retain the patients laryngeal function.

Key words: Hypopharyngeal cancer, Esophagus, Reconstructive surgical procedures, Survivalrate, Laryngeal function