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Changing Trends in Reconstrution after Resection of Hypopharyngeal Carcinoma

下咽癌根除性手術後重建方式的改變趨勢

摘要


背景:下咽癌在頭頸癌中是一項相對稀少且預後不佳的疾病,徹底的喉咽切除術併術後放射線治療為下咽癌治療中很重要的一環。針對喉咽切除後缺損有許多重建方式,但迄今何者是最好的重建方式還沒有定論。方法:我們針對本院於1986年至2010年接受根除性手術的下咽癌病患進行病歷回溯性研究,分析在與整形外科共同手術前後,不同的時期重建方式改變的趨勢,並對發生的術後併發症進行統計分析討論。結果:總共納入305名下咽癌病患,全數皆接受全喉及全/部分咽切除手術,並依與整形外科共同手術前(n=253)、後(n=52)分為兩個群組。分析後發現重建方式由共同手術前以胸大肌肌皮瓣及喉氣管瓣重建,改變成以游離皮瓣重建為主。共同手術後群組病患有較後期的腫瘤分期及較高的術後放射治療機率。術後整體、早期及晚期併發症機率各為50%、43%、22%。是否共同手術並不影響術後併發症機會。在經過多變數分析後發現環狀咽喉缺損是唯一與術後整體、早期及晚期併發症皆相關的因子。此外,性別在晚期併發症中也具統計學意義。結論:在本院,下咽癌經喉咽切除術後的缺損重建方式,已由與整形外科共同手術前的胸大肌肌皮瓣及喉氣管瓣重建,改變成游離皮瓣重建為主。是否共同手術並不影響併發症機率。環狀咽喉缺損仍是影響術後併發症最重要的因子。對於重建方式的的選擇仍然需要依據病患的臨床情形及臨床醫師的經驗來做抉擇。

關鍵字

全喉切除術 下咽癌 併發症 重建

並列摘要


BACKGROUND: Hypopharyngeal cancer is a relatively uncommon primary head and neck cancer with poor prognosis. Radical laryngopharyngectomy followed by radiotherapy has played an important role in its treatment policy. Many reconstructive methods had been developed for the repair of hypopharyngeal defect and there is still no consensus for which is the best. METHODS: We retrospectively reviewed the records of 305 patients from 1986 to 2010 who underwent radical laryngopharyngectomy and reconstruction in our department. The changing trends of reconstruction methods before and after combined surgery with plastic surgery department was observed and demographic data, post-operative complications of the different reconstructive period were compared. RESULTS: We divided the patient into two groups: before combined surgery (n=253) and after combined surgery (n=52) with plastic surgery department. The significant changing trend of the reconstructive method shifted from pectoralis major myocutaneous flap (PMMCF) and laryngotracheal flap (LTF) to free fasciocutaneous flap. After combined surgery group had significant more advanced T stage, N stage, and postoperative radiotherapy rate. The overall, early and late complication occurred in 152 (50%), 123 (43%) and 68 (22%) patients respectively. The postoperative complications showed no significant difference between the two reconstruction time periods. After adjusting in a multiple logistic regression model, the circumferential pharyngeal defect is the only significant predictor for overall, early, and late post-operative complications. In addition, gender also played a significant role in late postoperative complications. CONCLUSIONS: The changing trend of hypopharyngeal reconstructive methods had been observed from PMMCF and LTF to free fasciocutaneous flap in our institute. Similar postoperative complication rates were achieved between before and after combined surgery group, even though the after combined surgery group had more advanced stages of disease. Circumferential pharyngeal defect was the most important predictor for postoperative complications. The choice of the reconstruction method should still depend on the clinical condition of patient and the surgeon's familiarity and experience.

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