- 期刊
The Effect of Preoperative Radiotherapy versus the Immediate Success of Reconstruction Using Microsurgical Jejunum Flap
術前放射治療對於空腸皮瓣重建立即成功率的影響
摘要
使用自由空腸皮瓣已成為咽食道重建之標準方式。而術前放射治療會引起組織纖維化並干擾傷口癒合。於動物實驗已知放射線照過的血管有較高栓塞率，然而臨床上仍未知術前放射治療是否會影響重建成功率及早期併發症發生率。 自1998年4月至2003年4月間共46位病人切除頭頸部癌後接受空腸移植重建，所有重建步驟都由同一手術者執行。我們蒐集病人年齡、性別、缺血時間、早期併發症，皮瓣存活情形等資料，並根據病人是否有術前放射治療分為兩組；第一組－接受過放射治療，第二組－未接受放射治療。 所有空腸皮瓣都存活，早期併發症包含血管栓塞和腸縫合處滲漏率則用來比較。第一組共有22位病人，其併發症率為22.7%；第二組共有24位病人，併發症率20.8%，兩組統計上無顯著差別。 理論上，放射治療後咽食道重建因組織纖維化及缺乏好的血管而增加困難度。但本篇報告結果為術前頭頸放射治療未增加皮瓣重建之併發症率，可能與病人皆於放射治療三個月後才進行重建，並挑選大的血管有關。
關鍵字
無資料並列摘要
Reconstruction of the pharyngoesophagus with free jejunal transfer has become the standard technique. Preoperative radiation therapy causes tissue fibrosis and interferes with wound healing. In animal model radiated vessels have higher thrombosis rate. However, clinically it is not clear whether irradiation before surgery will affect the early complications and the success rate of reconstruction. Between April 1998 and April 2003, 46 patients underwent free jejunum flap reconstruction after ablative resection of head and neck cancer at Chang Gung Memorial Hospital in Linkou. All the reconstructions were performed by the same surgeon. Data were collected regarding patients' age and sex, ischemia time, early complications and flap viability. According to whether there was preoperative radiotherapy or not, the patients were divided into two groups. Group Ⅰ had been irradiated. Group Ⅱ had been non-irradiated. All the flaps survived. The early complications such as vascular occlusion and enteral anastomosis leak were compared. There were 22 cases in Group Ⅰwith the complication rate of 22.7%, 24 patients in Group Ⅱ with the complication rate of 20.8%. There was no significant statistical difference. (Chi-square test, p＜0.05) Theoretically pharyngoesophageal reconstruction after radiation therapy is more difficult due to tissue fibrosis and lack of good recipient vessels. But in this series, previous neck irradiation did not appear to have adverse effect on flap viability and complication rate.
延伸閱讀
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