Swallowing Function after Reconstruction of Pharynx and Cervical Esophagus──A Comparison Among Jejunal Flap, Colon Flap and Anterolateral Thigh Flap with Postoperative Rehabilitation

以空腸、結腸及大腿前外側皮瓣進行咽頸部食道重建術經復健後吞嚥功能之比較

黃琪雯(Chi-Wen Huang) ； 陳信翰(Shih-Heng Chen) ； 翁慧卿(Hui-Chin Weng) ； 丁承原(Sung-Won Jung) ； 李宗勳(Tzong-Shiun Li) ； 陳宏基(Hung-Chi Chen)

《臺灣整形外科醫學會雜誌》 25卷1期 (2016/03) Pp. 27-36

摘要

背景：接受頸部腫瘤切除或者食道灼傷的患者，經重建後都會導致吞嚥功能的改變，因此食道重建為恢復病患進食功能的一項重要之重建指標性技術。目前的頸部食道重建有幾種方式，例如使用胃、結腸、空腸或皮瓣。然而，而這些重建後的食道其性能與天生的食道之間都有相當大的差異，故需以復健來恢復接進正常的吞嚥功能，而所需的時間皆不相同。目標及目的：對於空腸、結腸或皮瓣所進行的食道重建，經復健訓練的介入，比較三者恢復到可進食半固體且完全不需要依靠管灌餵食的時間之差異。材料及方法：本研究收集自西元2010至2014年間，共3位女性及19位男性之接受頸部食道重建患者，做回溯性之病歷回顧，並做統計分析。吞嚥功能的分析重點在於比較患者可以進食到半固體所需的時間，另外，也針對患者分析在接受手術後一年的體重之變化。結果：關於吞嚥功能的訓練所需之時間，發現接受空腸重建比結腸重建和皮膚重建所需的時間較短，但在體重的變化方面並無顯著差別。結論：以目前整形外科的發展，幾乎所有的食道切除後皆可以重建，以復健協助病人恢復接進正常的吞嚥功能。就吞嚥而言，空腸移植最容易進食。但若有解剖學上的狹窄處，則需以外科方式處理，以免發生吸入性肺炎等危險。

並列摘要

Background: The function of swallowing is a major goal after reconstruction for pharynx and cervical esophagus. Several reconstructive methods have been developed, and each of them has different characteristics. Aim and objectives: The jejunal flap, colon flap or skin flap were used for pharynx and cervical esophagus reconstruction. After rehabilitation training the time required to achieve swallowing with semisolid diet and without any tube feeding was recorded for analysis. Materials and Method: We used the retrospective study and the patient data were drawn from the medical records. Among the 70 cases of esophageal reconstruction from 2010 to 2014 we followed up 22 patients who were able to accept regular physiotherapy for swallowing, including 19 male and 3 female who accepted the reconstruction of pharynx and cervical esophagus with jejunal flap, colon flap or anterolateral thigh flap (ALT flap). All flaps survived. After wound healing esophagography was done before they started to eat. The time required to achieve swallowing of semisolid diet without tube feeding was recorded. Results: Comparing the swallowing function following jejunal flap, colon flap and ALT flap, the jejunal flap is better than colon flap or ALT flap. Conclusion: If the patients have long life expectancy and there is no contra-indication of laparotomy, jejunal flap should be the first choice to obtain optimal swallowing function. (J Taiwan Soc of Plast Surg 2016;25:27～36)

並列關鍵字

swallowing ； anterolateral thigh flap ； jejunal flap ； colon flap ； cervical esophagus