- 期刊
經喉氣管縱向切除及喉氣管瓣重建術治療晚期下咽癌
Laryngotracheal Fissure Approach and Laryngotracheal Flap Reconstruction for Advanced Hypopharyngeal Cancer
摘要
背景:晚期下咽癌的手術治療，通常在施以徹底的切徐後，必須使用許多複雜的方法重建下咽吞嚥道缺損。為簡化手術切除及重建的方法，我們遂根據下咽癌的侵犯特性，使用一種經喉氣管縱切的手術方法，迅速暴露並徹底切除腫瘤，同時也保留部份正常的喉氣管組織，做為重建吞嚥道的喉氣管瓣。 方法:自1991年8月至1996年12月間，我們對所有未侵犯對側喉部及梨狀竇的下咽癌病患，施行這種手術法。手術時向上以喉氣管縱切方式進入咽喉腔，在清楚視野下直接將腫瘤、鄰近組織及頸部廓清術切下的組織，做整體摘除，接著再使用喉氣管瓣完成下咽吞嚥道的重建。 結果:在這段時間，共50例病患以這種手術方法治療，沒有任何全環狀吞嚥道缺損的病例發生。其中38例 (76%)順利以喉氣管瓣直接重建其吞嚥道，其餘12例 (24%)因為切除範圍較大，尚需胸大肌肌皮瓣以補舖方式與喉氣管瓣共同重建吞嚥道缺損。術後吞嚥功能方面，除了1例於放射治療後產生咽喉食道狹窄，其餘均十分理想。在追蹤期間，均無局部復發 ; 頸部轉移有7例，多發生於未做頸部廓清術的一側。 結論:由我們長期經驗認為，本方法減低了傳統手術的腹雜性和損害性。對晚期下咽癌病患，這是一個簡單可靠、而且實用性頗高的手術方法，值得採行。
並列摘要
Objectives: Redical surgery for advanced hypopharyngeal cancer usually includes neck dissection, total laryngectomy, partial or total pharyngectiomy, and swallowing conduit reconstruction. Miscellaneous reconstruction techniques have been propsed. To simplify the approach and reconstruction for advanced hypopharyngeal cancer, a modified technique-laryngotracheal fissure approach and laryngo-tracheal flap reconstruction is presented. Methods: From August 1991 to December 1996, 50 consecutive patients with advanced hypopharyngeal cancer were operated upon using this technique. The functional and oncologic results and complications were recorded and evaluated. Results: No circumferential defect was created. The reconstruction was completed by using the laryngotracheal flap in 76% patients, while the other 24% required additional patch-on pectoralis major myocuta flap. Pharyngoesophageal stenosis wasnoted in one patient after radiotherapy and pharyngocutaneous fistula was noted in two. No local recurrence was noted. Seven cervical metastasis developed in the follow-up period. The 5-year Kaplan-Meier diseas-free survival was 45.1%. Conclusions: The authors’ experience revealed this technique as a simplified, radical treatment for most advanced hypopharyngeal cancer, with high applicability, good oncologic results and low complication rate.
延伸閱讀
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