CAJ | 학술논문

目的探讨胸大肌肌皮瓣卷筒在晚期喉咽及颈段食管肿瘤切除术后环周缺损修复中应用的可行性及远期疗效.方法回顾性分析2004年12月至2008年10月对30例头颈鳞癌原发灶肿瘤切除后出现下咽和颈段食管环周缺损的患者选择行胸大肌肌皮瓣卷筒修复的临床资料.其中下咽癌22例,颈段食管癌7例,喉癌术后放疗后复发累及下咽1例.术前接受放疗者5例,外院手术后复发者3例.采用全喉全下咽切除者12例,全喉全下咽切除颈段食管切除者18例,均行胸大肌肌皮瓣卷筒修复.结果术后咽瘘4例,其中2例有术前放疗史,2例有糖尿病史,均换药治愈.2例患者出现吻合口狭窄,均位于口咽部上吻合口处,经反复扩张后缓解,术后吞咽功能均恢复.全部患者均进行随诊,术后随访时间8～56个月,中位随访时间18个月.以Kaplan-Meier法计算生存率,1年及3年生存率分别为71.4%及42.5%.结论胸大肌肌皮瓣卷筒修复晚期咽喉及颈段食管肿瘤切除后的下咽和颈段食管环周缺损效果可靠.可用于放疗及手术后复发肿瘤切除后环周缺损的修复.
목적 탐토흉대기기피판권통재만기후인급경단식관종류절제술후배주결손수복중응용적가행성급원기료효.방법 회고성분석2004년12월지2008년10월대30례두경린암원발조종류절제후출현하인화경단식관배주결손적환자선택행흉대기기피판권통수복적림상자료.기중하인암22례,경단식관암7례,후암술후방료후복발루급하인1례.술전접수방료자5례,외원수술후복발자3례.채용전후전하인절제자12례,전후전하인절제경단식관절제자18례,균행흉대기기피판권통수복.결과 술후인루4례,기중2례유술전방료사,2례유당뇨병사,균환약치유.2례환자출현문합구협착,균위우구인부상문합구처,경반복확장후완해,술후탄인공능균회복.전부환자균진행수진,술후수방시간8～56개월,중위수방시간18개월.이Kaplan-Meier법계산생존솔,1년급3년생존솔분별위71.4%급42.5%.결론 흉대기기피판권통수복만기인후급경단식관종류절제후적하인화경단식관배주결손효과가고.가용우방료급수술후복발종류절제후배주결손적수복.
Objective To investigate the feasibility and efficacy of tubed pectoralis major myocutaneous flap in the reconstruction of circumferential defects following resection for locally advanced hypopharygeal and cervical esophageal carcinoma. Methods From Dec. 2004 to Oct 2008, 30 patients underwent immediate reconstruction by tubed pectoralis major myocutaneous flap for circumferential defects following resection of primary tumours. Among them, 22 were hypopharyngeal carcinoma, 7 were cervical esophageal carcinoma and one was recurrent laryngeal carcinoma involved the hypopharyngeal lumen. Five of 30 patients had received previous radiotherapy and three had failed in the previous surgical procedure. In this series, 12 patients had total pharyngolaryngectomy and 18 had total pharyngolaryngectomy and partial cervical esophagectomy. Results Postoperative pharyngocutanous fistula formation occurred in 4 patients, 2 of them with previous radiotherapy and 2 with diabetes, and the fistulae healed later. Two patients developed anastomotic strictures at the upper junction, but they had good respondses to dilatation treatment and had satisfactory oral intake. The postoperative follow-up time ranged from 8 to 56 months. Median follow-up was 18 months. One-year survival rate was 71.4% and three-year survival rate was 42.5%. Conclusions The tubed pectoralis major myocutaneous flap is a reliable procedure to reconstruct hypopharyngeal circumferential defects following resection of advanced hypopharygeal and cervical esophageal carcinoma. This method may be the optimal choice for the reconstruction of hypopharyngeal circumferential defects following resection of recurrent carcinoma. The incidence of fistula and stenosis could be kept at an acceptable level.