Ullah R, Bailie N, Kinsella J, Anikin V, Primrose W J, Brooker D S
Department of Otorhinolaryngology-HNS, Royal Victoria Hospital, Belfast, UK.
J Laryngol Otol. 2002 Oct;116(10):826-30. doi: 10.1258/00222150260293655.
Pharyngo-laryngo-oesophagectomy and gastric pull-up (PLOGP) is a complex and relatively uncommon procedure. The aim of this study is to analyse the results of PLOGP in patients with post-cricoid and cervical oesophageal squamous cell carcinomas. This study was a retrospective review of 26 patients (11 males + 15 females, mean age 63.5 years) who underwent PLOGP from 1988 to 1997. Eighteen (69 per cent) patients were staged as T(3) and eight (31 per cent) T(4). Eighteen (69 per cent) patients had N(0), seven (27 per cent) N(1) and one (four per cent) N(2) disease. Multiple primary tumours were recorded in three (11.5 per cent) patients. Four (15 per cent) patients had pre-operative radiotherapy with poor response and two (eight per cent) required emergency tracheotomy prior to surgery. Feeding jejunostomy was performed on 19 (73 per cent) and neck lymph node dissection in eight (31 per cent) patients. The mean duration of surgery was five hours (range 3.5 to 7.5) with a mean blood loss of 840 ml (range 160 to 1800), a mean stay in ICU of 4.2 days and hospital stay ranged from nine to 84 days (mean 34). Three (11.5 per cent) patients died (pneumonia - one, congestive heart failure - one, pulmonary embolus - one) in the early post-operative period. Eight (31 per cent) patients remain alive from 30 to 136 months (mean 58 months). Two (eight per cent) patients died with no evidence of disease. Thirteen (50 per cent) patients died of their disease between two to 51 months (mean 17.3 months) post-operatively. Kaplan-Meier survival estimates for one year was 65 per cent, for three years 35 per cent and for five years 26 per cent (see Figure 1). Median survival in the whole series was 18 months. Post-operative speech was with an electrolarynx in 16 (62 per cent). One patient (four per cent) used gastric speech and one patient (four per cent) used a Blom-Singer valve effectively. Five (19 per cent) patients had no speech post-operatively. All patients maintained oral feeding. Gastric transposition constitutes a safe and reliable method of restoring the continuity of the upper digestive tract following pharyngo-laryngo-oesophagectomy.
下咽-喉-食管切除术及胃上提术（PLOGP）是一种复杂且相对不常见的手术。本研究的目的是分析PLOGP治疗环状软骨后和颈段食管鳞状细胞癌患者的结果。本研究是一项对1988年至1997年间接受PLOGP手术的26例患者（11例男性 + 15例女性，平均年龄63.5岁）的回顾性研究。18例（69%）患者分期为T(3)，8例（31%）为T(4)。18例（69%）患者为N(0)，7例（27%）为N(1)，1例（4%）为N(2)期疾病。3例（11.5%）患者记录有多发原发性肿瘤。4例（15%）患者术前放疗效果不佳，2例（8%）患者术前需要紧急气管切开。19例（73%）患者行空肠造瘘术，8例（31%）患者行颈部淋巴结清扫术。平均手术时间为5小时（范围3.5至7.5小时），平均失血量为840毫升（范围160至1800毫升），平均在重症监护病房停留4.2天，住院时间为9至84天（平均34天）。3例（11.5%）患者在术后早期死亡（1例死于肺炎，1例死于充血性心力衰竭，1例死于肺栓塞）。8例（31%）患者存活30至136个月（平均58个月）。2例（8%）患者无疾病证据死亡。13例（50%）患者术后2至51个月（平均17.3个月）死于疾病。Kaplan-Meier生存估计1年为65%，3年为35%，5年为26%（见图1）。整个系列的中位生存期为18个月。16例（62%）患者术后使用电子喉发声。1例（4%）患者使用胃发音，1例（4%）患者有效使用Blom-Singer瓣膜。5例（19%）患者术后无法发声。所有患者均维持经口进食。胃移位是下咽-喉-食管切除术后恢复上消化道连续性的一种安全可靠的方法。
