- 期刊
Assessment of Swallowing Function of Patients with Free Ileocolic Flap Reconstruction after Total Pharyngolaryngectomy
全咽喉切除術後以“迴－結腸”自由組織重建患者吞嚥功能之探討
摘要
吞嚥以及發音功能是接受全咽喉切除術後患者最關心的問題。如果能夠在術後快速的重建吞嚥以及發音功能，會使這類病人較願意接受手術。本院於2003年1月到2004年12月，應用「迴－結腸」自由皮瓣重建12位接受全咽喉切除術患者之吞嚥及發音功能。這些患者平均年齡51.9歲，皆為男性。吞嚥功能是以食道攝影及合併性放射－化學治療(CCRT)前後的進食型態來評估。其中4位在兩年追蹤期間，分別因為癌症復發、轉移或自殺死亡。所有皮瓣在初期均存活，但有一例皮瓣在術後7個月壞死。有一例呈現下端接口處食道狹窄，一例出現咽－皮膚屢管。三例於吞嚥時有嗆咳現象，但均無吸入性肺炎發生。只有一例持續吞嚥困難而必須長期依賴管灌餵食，其餘病患皆能回復吞嚥功能。重建吞嚥功能的成功率為92%。我們認為：「迴－結腸」自由皮瓣是重建接受全咽喉切除術患者之吞嚥功能的理想方法。同時重建發音功能並不會妨礙吞嚥功能的恢復。
關鍵字
無資料並列摘要
Functions for swallowing and phonation are the major concerns for patients after total pharyngolaryngectomy. The possibility of rapid restoration of swallowing and phonation function would be an important motivating factor for surgery for these patients. From January 2003 to December 2004, 12 consecutive patients, all male, aged from 33 to 69 years old (average 51.9), received free ileocolic flap reconstruction after total pharyngolaryngectomy. The swallowing function was evaluated by esophagogram and feeding patterns before and after concurrent combined chemo-radiotherapy (CCRT). Four cases died of tumor recurrence, metastasis or suicide in the 2 years follow up. All flaps survive well in early post-operative period, but one late flap failure due to damage of vascular pedicle 7 months after the initial operation. One case showed inferior junction stricture by esophagogram, and one presented pharyngocutaneous fistula. Choking was noted in three cases, but none developed aspiration pneumonia. One case was noted to be prolonged dysphagia and was dependent upon tube feeding. Others got good swallowing function after the operation. The rate in successful restoration of swallowing function of this procedure is 92%. Free ileocolic flap is an ideal flap for swallowing function restoration for the patients after total pharyngolaryngectomy. Simultaneous reconstruction of phonation will not interfere with the patients' swallowing.
延伸閱讀
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