CAJ | 학술논문

目的探讨晚期下咽癌的外科治疗以及术后下咽及颈段食管缺损修复重建的方法和疗效.方法回顾性分析25例下咽癌患者的手术方式及修复方法.其中梨状窝癌17例,下咽后壁区癌3例,环后癌5例.其中T4N0M0 9例,T4N1M0 11例,T4N2M0 5例.喉下咽食管全切除后胃代食管的咽胃吻合术7例,喉下咽颈段食管全切除游离空肠代下咽颈段食管术4例,残喉气管瓣修复下咽、颈段食管部分切除后咽部缺损8例,胸大肌肌皮瓣修复下咽、颈段食管部分切除后咽部缺损6例.所有患者颈部均行改良性和(或)择区性颈清扫.其中术前放疗8例,术后放疗17例.结果 25例患者无术中死亡,术后所有患者均恢复了正常吞咽功能,5例喉功能保留的患者不同程度的恢复了呼吸和发音功能.术后随访3～5年,无失访患者.1年内死亡3例,1、3、5年生存率分别为88.0%、48.0%和28.0%.结论下咽及颈段食管缺损一期修复方法的应用扩大了下咽癌的手术适应证,提高了晚期下咽癌患者的生存率和生活质量.在修复方法的选择方面,肿瘤部位和手术后组织缺损的大小是选择修复方法的主要因素,同时还应结合患者的年龄和全身状况等因素,以期最大可能地减少并发症的发生.
목적 탐토만기하인암적외과치료이급술후하인급경단식관결손수복중건적방법화료효.방법 회고성분석25례하인암환자적수술방식급수복방법.기중리상와암17례,하인후벽구암3례,배후암5례.기중T4N0M0 9례,T4N1M0 11례,T4N2M0 5례.후하인식관전절제후위대식관적인위문합술7례,후하인경단식관전절제유리공장대하인경단식관술4례,잔후기관판수복하인、경단식관부분절제후인부결손8례,흉대기기피판수복하인、경단식관부분절제후인부결손6례.소유환자경부균행개량성화(혹)택구성경청소.기중술전방료8례,술후방료17례.결과 25례환자무술중사망,술후소유환자균회복료정상탄인공능,5례후공능보류적환자불동정도적회복료호흡화발음공능.술후수방3～5년,무실방환자.1년내사망3례,1、3、5년생존솔분별위88.0%、48.0%화28.0%.결론 하인급경단식관결손일기수복방법적응용확대료하인암적수술괄응증,제고료만기하인암환자적생존솔화생활질량.재수복방법적선택방면,종류부위화수술후조직결손적대소시선택수복방법적주요인소,동시환응결합환자적년령화전신상황등인소,이기최대가능지감소병발증적발생.
Objective To explore the surgical treatment of hypopharyngeal and cervical esophageal cancers and the ways of reconstruction after hypopharyngo-oesphagectomy, and to evaluate their efficacy.Methods Twenty five patients with cancer of the laryngopharynx and cervical esophagus treated in our department between 1995 and 2007 were included in this study. Their clinical data were restrspectively analyzed. Among them, 17 cases had the tumor originated from the pyriform sinus, 3 of the posterior pharyngeal wall and 5 of the postcricoid region. Acording to the 2002 UICC criteria, all the tumors were stage T4, including 9 patients with cN0, 11 with cN1, and 5 with cN2 disease. The pharyngoesophageal defect reconstruction methods were as following: pharyngogastric anastomosis in 7 patients, free jejunal transplantion in 4, laryngotracheal flap in 8, and pectoralis major musculocutaneous flap in 6 patients. All patients were treated with modified and/or selective neck dissection. Among them, 8 cases received preoperation radiotherapy, 17 received post-operative auxiliary radiotherapy. Results There was no operation death case in this group. All patients were followed up for 3 to 5 years. Three patients died in the first year.According to Kaplan-Meier analysis, the 1 -year survival rate was 88.0%, 3-year survival rate was 48.0%,and S-year survival rate was 28.0%. Conclusions The use of primary repair of the defects of laryngopharynx and cervical esophagus expands the operative indication for cancers of the laryngopharynx and cervical esophagus, improves the survival rate and life quality of the patients. Regarding the repair method of choice, site of the tumor and size of the defect are the most important factors regarding choice of reconstruction method, while the patients' age and general condiction should also be considered to minimize the complications as more as possible.