Couch Marion Everett
Department of Otolaryngology-Head and Neck Surgery, The Johns Hopkins Outpatient Center, Room 6254, 601 North Caroline Street, Baltimore, MD 21287, USA.
Otolaryngol Clin North Am. 2002 Oct;35(5):1097-114. doi: 10.1016/s0030-6665(02)00034-8.
A wide range of reconstructive options allows the ablative surgeon to resect tumors completely with wide margins. Wide resection is especially important because of the rich lymphatic drainage and submucosal spread seen with carcinomas in the hypopharyngeal area. Postoperative stenosis can be a difficult, recurring problem if the neopharynx does not have enough tissue incorporated into the closure. Therefore, most laryngopharyngectomy procedures benefit from the addition of transposed tissue, either pedicled or using free tissue transfer microvascular techniques. Often the location of the tumor is a major factor in determining which reconstruction is best for the patient. Minimizing the donor-site morbidity must be carefully considered, also.
多种重建选择使切除外科医生能够在保证切缘足够宽的情况下完整切除肿瘤。广泛切除尤为重要，因为下咽区域的癌具有丰富的淋巴引流和黏膜下扩散。如果下咽没有足够的组织用于关闭，术后狭窄可能是一个棘手的、反复出现的问题。因此，大多数喉咽切除术都受益于添加带蒂转移组织或采用游离组织移植微血管技术。肿瘤的位置通常是决定哪种重建方式最适合患者的主要因素。同时，也必须仔细考虑尽量减少供区并发症。
