下咽癌手術重建方法之分析

Reconstruction after Resection of the Hypopharyngeal Cancer

馮志禾(Chih-Ho Feng) ； 張學逸(Shyue-Yih Chang) ； 黃瑞麟(Jui-Lin Huang) ； 蕭安穗(An-Suey Shiao) ； 戴世光(Shyh-Kuan Tai) ； 朱本元(Pen-Yuan Chu)

《台灣耳鼻喉頭頸外科雜誌》 40卷6期 (2005/10) Pp. 222-229

https://doi.org/10.6286/2005.40.6.222

摘要

背景：下咽癌在診斷時多為晚期，預後通常也較差。手術切除輔以術後放射治療仍是晚期下咽癌主要的治療方式之一。然而廣泛切除手術往往會造成較大的咽食道缺損，而需要使用其他的組織瓣做重建。本研究主要的目的在分析下咽癌病患經廣泛手術切除後，以不同的方式重建的結果，並提出我們的經驗。
方法：收集自1992至2000年間，135名過去未曾治療過的下咽癌病患，經廣泛手術切除，包括喉全切除術及咽部份或全切除術、食道部份或全切除術，而導致部份或環形咽食道缺損，手術後並以直接縫合或其他各種不同方式做重建。我們將比較各種不同重建的方法其術後產生的併發症。
結果：有109名病患(81%)接受咽部份切除術，而產生部份咽部缺損；26例(19%)接受咽全切除手術及食道部份或全切除術，而產生環狀咽食道缺損。咽食道缺損重建包括直接縫合（21例）、喉氣管瓣（62例）、胸大肌肌皮瓣（18例）、合併喉氣管瓣及胸大肌肌皮瓣（17例）、胃移重建法（13例）、及游離皮瓣（4例）做重建。5年整體存活率為48%，5年疾病相關存活率59%。術後併發症為40%，其中咽痒皮管發生率為13%，咽食道狹窄的發生率為7%，使用喉氣管瓣合併胸大肌肌皮瓣重建的方式有最低的咽皮痒管(0%)及咽食道狹窄發生率(0%)。
結論：下咽癌廣泛切除手術後，以喉氣管瓣或合併胸大肌肌皮瓣做重建，可減少其他複雜重建方法的使用，是一種簡單方便、可靠性高且術後併發症低的方式。

關鍵字

下咽癌 ； 手術治療 ； 下咽重建 ； 併發症

並列摘要

BACKGROUND: Hypopharyngeal carcinoma usually presents at advanced stages and the prognosis is poor. Radical surgery followed by postoperative radiation therapy plays an important role in advanced diseases. However, radical surgery may result in a large surgical defect, which would need reconstruction with flaps. The purpose of this study is to analyze the results of different reconstructive methods following surgical resection.
METHODS: From 1992 to 2000, 135 patients with advanced hypopharyngeal carcinoma treated with surgery in our institute were reviewed. All patients received total laryngectomy, partial or total pharyngectomy with or without partial or total esophagectomy. The postoperative complications and oncologic outcomes of different reconstructive methods were retrospectively analyzed.
RESULTS: Of the 135 patients, 109 patients (81%) had partial pharyngectomy and 26 patients (19%) had total pharyngectomy with or without esophagectomy. The pharyngeal defects were reconstructed with different methods, including primary closure, contralateral laryngotracheal flap (LTF), pectoralis major myocutaneous flap (PMMCF), free flap and gastric pull-up. The 5-year overall and disease-specific survival were 48% and 59%, respectively. The incidence of pharyngocutaneous fistula (PCF) and pharyngoesophageal stenosis (PES) was 13% and 7%. Reconstruction with LTF and patch-on PMMCF had the lowest PCF (0%) and PES (0%).
CONCLUSION: Hypopharyngeal reconstruction with LTF is a simple and effective method. The postoperative complications are reduced and oncologic results are satisfactory.

並列關鍵字

hypopharyngeal carcinoma ； surgical treatment ； hypopharyngeal reconstruction ； complication