下咽后壁癌手术治疗.docVIP

下咽后壁癌手术治疗 　【摘要】 目的：探讨下咽后壁癌手术切除及术后组织缺损不同修复重建方法的经验和疗效。方法：1992年2月至2004年4月山东大学齐鲁医院耳鼻咽喉－头颈外科手术治疗下咽后壁癌35例，其中20例（Ⅰ期2例、Ⅱ期7例、Ⅲ期8例、Ⅳ期3例）保留全部或部分喉功能，15例（Ⅲ期2例、Ⅳ期13例）未保留喉功能。19例行单侧择区性或改良根治性颈清扫，15例行双侧颈清扫。采用咽前切开进路或咽侧入路，完整切除肿瘤后修复下咽缺损。33例患者术后接受放射治疗。结果：35例下咽癌患者术后全部恢复吞咽功能，20例保留喉功能者术后均获得发音功能，其中15例拔除气管套管。3年、5年生存率分别为44.4％（12/27）、31.6％（6/19）。结论：手术治疗可一期切除下咽后壁癌并整复下咽缺损，T1、T2期和经选择的T3、T4期肿瘤患者可保留喉功能。根据病变具体情况，应用局部黏膜牵拉缝合、裂层皮片、胸大肌肌皮瓣、喉气管黏膜瓣、胃、结肠等方法和材料可重建咽－食管通道。 【关键词】 下咽肿瘤 外科手术 下咽重建 ［ABSTRACT］ Objective：To study the surgical treatment and the simultaneous reconstruction methods for posterior hypopharyngeal wall carcinoma. Methods: Thirtyfive cases of the posterior hypopharyngeal wall carcinoma were retrospectively reviewed. According to UICC 1997 criteria, there were 2 in stageⅠ, 7 in stage Ⅱ, 10 in stage Ⅲ, and 16 in stage Ⅳ. Twenty cases preserved the complete or partial laryngeal functions and 15 cases accepted the total laryngectomy. Nineteen cases underwent an unilateral elective or modified radical neck dissection and 15 underwent a bilateral neck dissection. Thirtythree patients received radiotherapy postoperatively (5070?Gy). Results: The deglutition function was restored within 2 months. Vocal function was acquired in 20 patients preserving the laryngeal function and trachea cannulas were removed in 15 patients. The 5 and 3year survival rates were 31.6％（6/19）and 44.4％（12/27）, respectively. Conclusion: Carcinoma of the posterior hypopharyngeal wall are few in clinic. Surgical resection and onestage hypopharyngeal reconstruction are feasible. The pharyesophagus passage could be restored by retaining the mucosa, pectoralis major myocutaneous flap, laryngotracheal flap, split skin flap, stomach transposition and colon interposition etc. ［KEY WORDS］ Hypopharyngeal neoplasms; Surgery, operative; Hypopharyngeal reconstruction 下咽后壁癌发病率较低，Hoffman等［1］报道占下咽癌的8.9％；国内报道为8.6%［2］。下咽后壁癌位置隐蔽，早期缺乏典型症状而难以发现，确诊时原发灶范围多较大，癌肿易于黏膜下广泛扩散，甚至侵入口咽及颈段食管，并且容易发生颈内静脉周围淋巴结及咽后淋巴结的转移，双侧转移者多见。1992年2月至2004年4月山东大学齐鲁医院耳