CAJ | 학술논문

目的分析下咽及食管癌手术切除后,胃上提后不足以达到口咽部时,残喉或空肠接力胃代食管术的方法.方法 2010年6月至2014年6月,5例下咽及食管癌患者在中国医学科学院肿瘤医院头颈外科行胃代食管术中出现胃上提后长度不足,不能完成咽胃吻合.2例喉受侵,采用游离空肠,3例利用未受侵而预留的残喉,分别接力延长胃,而完成胃代食管术.结果除1例术后第12天出现喉胃吻合口短时间小咽漏外,其余均术后2周恢复经口进食,伤口一期愈合,未发现其他并发症.1例术后随诊3年后因纵隔及肺转移死亡,1例2年后颈部复发,现带瘤生存,其余3例至目前无瘤生存分别为28、37、56个月.结论如果术中出现胃上提后不能达到口咽部,颈部出现一段缺损,采取胃加游离空肠或胃加残喉两种组织接力修复的办法,均可完成上消化道重建.
목적 분석하인급식관암수술절제후,위상제후불족이체도구인부시,잔후혹공장접력위대식관술적방법.방법 2010년6월지2014년6월,5례하인급식관암환자재중국의학과학원종류의원두경외과행위대식관술중출현위상제후장도불족,불능완성인위문합.2례후수침,채용유리공장,3례이용미수침이예류적잔후,분별접력연장위,이완성위대식관술.결과 제1례술후제12천출현후위문합구단시간소인루외,기여균술후2주회복경구진식,상구일기유합,미발현기타병발증.1례술후수진3년후인종격급폐전이사망,1례2년후경부복발,현대류생존,기여3례지목전무류생존분별위28、37、56개월.결론 여과술중출현위상제후불능체도구인부,경부출현일단결손,채취위가유리공장혹위가잔후량충조직접력수복적판법,균가완성상소화도중건.
Objective To explore a new method for the reconstruction of defect after resection of hypopharyngeal and cervical esophageal cancer using pulled-up stomach combined with free jejunal flap or lanryngotracheal flap if pulled-up stomach can not reach the level of oral pharynx for ananstamosis.Methods From June 2010 to June 2014,56 cases of hypopharyngeal or cervical esophageal cancer were treated with pharyngogastric anastamosis,in 5 cases of them,because the length of pulled-up stomach was limited and could not reach oral pharynx,free jejunal flap was used in 2 cases with laryngeal invasion and laryngotracheal flap was used in 3 cases without laryngeal invasion to reconstruct the defect between oral pharynx and stomach.Results Pharyngeal fistula occurred in 1 case with laryngotracheal flap reconstruction,but healed after 2 weeks of wound dressing.Other 4 cases had oral liquid diet two weeks after surgery and did not occur any complications such as infection or pharyngeal fistula.Follow-up showed 1 case died from mediastinal and lung metastases after 3 years,1 case had cervical lymph recurrence after 2 years and still survived,and other 3 cases were tumor free survival for 28,37,and 56 months respectively.Conclusions The defect after resection of hypopharyngeal and esophageal cancer can be reconstructed with pulled-up stomach combined with free jejunal flap or lanryngotracheal flap if pulled-up stomach can not reach the level of oral pharynx for ananstamosis.