Genden E M, Kaufman M R, Katz B, Vine A, Urken M L
Department of Otolaryngology-Head and Neck Surgery, Box 1189, The Mount Sinai School of Medicine, One Gustave L. Levy Place, New York, NY 10029, USA.
Arch Otolaryngol Head Neck Surg. 2001 Jul;127(7):847-53.
Malignant lesions of the pharyngoesophagus often require total laryngopharyngectomy and mediastinal dissection. As a result of the current treatment paradigms for advanced laryngopharyngeal cancers, it is common that the surgical field has been previously irradiated or exposed to systemic chemotherapy, resulting in fistula rates as high as 78% and mortality as high as 8%. The free vascularized tubed gastric antrum and the accompanying greater omentum offer a single-staged method of pharyngoesophageal reconstruction, with the added benefit of protection of the great vessels, the tracheal stump, and the mediastinal contents in a high-risk surgical field.
To assess the gastro-omental free flap as a method of pharyngoesophageal reconstruction in patients who have been previously treated with multimodality therapy.
Five consecutive cases of gastro-omental free flap reconstruction after total laryngopharyngectomy were retrospectively reviewed. Each case was assessed for intraoperative, perioperative, and postoperative complications at the primary site of reconstruction and the donor site. Patients were also evaluated for their ability to maintain an oral diet. Patients were followed up for a minimum of 6 months after surgery.
Five patients aged 44 to 70 years (mean, 59 years) underwent gastro-omental free flap reconstruction after total laryngopharyngectomy. Five patients had received previous external beam irradiation, 2 had received systemic chemotherapy, and 4 had undergone previous surgery. There were no fistulae or flap complications. Three patients were successfully treated with esophageal dilation for strictures sustained 2 to 5 months after surgery, and a third patient was successfully treated with conservative management for a partial gastric outlet obstruction sustained 2 months after surgery. One patient died 3 months after surgery of distant metastatic disease. The remaining 4 patients currently tolerate an oral diet.
The tubed gastro-omental free flap offers a safe method of reconstructing the pharyngoesophageal segment in a surgical field compromised by previous multimodality therapy.
下咽食管恶性病变通常需要行全喉咽切除术及纵隔清扫术。由于目前晚期喉咽癌的治疗模式，手术野先前接受过放疗或全身化疗的情况很常见，这导致瘘管发生率高达78%，死亡率高达8%。带血管蒂的游离管状胃窦及附带的大网膜提供了一种一期下咽食管重建方法，在高风险手术野中还具有保护大血管、气管残端及纵隔内容物的额外益处。
评估胃网膜游离皮瓣作为先前接受多模式治疗患者下咽食管重建方法的效果。
回顾性分析5例全喉咽切除术后行胃网膜游离皮瓣重建的连续病例。评估每个病例在重建原发部位和供区的术中、围手术期及术后并发症。还评估患者维持经口饮食的能力。术后对患者进行至少6个月的随访。
5例年龄44至70岁（平均59岁）的患者在全喉咽切除术后接受了胃网膜游离皮瓣重建。5例患者先前接受过外照射放疗，2例接受过全身化疗，4例曾接受过手术。未发生瘘管或皮瓣并发症。3例患者术后2至5个月因狭窄成功接受食管扩张治疗，第3例患者术后2个月因部分胃出口梗阻成功接受保守治疗。1例患者术后3个月死于远处转移性疾病。其余4例患者目前能够耐受经口饮食。
带血管蒂的游离管状胃网膜皮瓣为在先前多模式治疗受损的手术野中重建下咽食管段提供了一种安全的方法。
