Scharpf Joseph, Esclamado Ramon M
Department of Otolaryngology and Communicative Disorders, A71, The Cleveland Clinic Foundation, 9500 Euclid Avenue, Cleveland, Ohio 44195, USA.
Head Neck. 2003 Apr;25(4):261-6. doi: 10.1002/hed.10197.
Patients afflicted with advanced hypopharyngeal cancer must contend with both potentially poor survival prognosis and a compromised quality of remaining life. After extensive ablative surgery, it is imperative to use a reliable, low morbidity reconstructive strategy that will allow for an expedient reconstitution of speech and swallowing.
Retrospective review of the records of 28 patients who underwent pharyngoesophageal reconstruction with radial forearm free flaps (RFFF) between 1996 and 2001 by a single surgeon (RE). Analysis was confined to patients requiring complete tubulation of the RFFF. Perioperative mortality, morbidity, and functional evaluation based on the parameters of speech and swallowing were analyzed.
Completely tubulated RFFF were required in 25 patients. There was 100% RFFF survival with no perioperative mortalities. The median hospital stay was 8.0 days. All patients acquired a reconstitution of oral alimentation; median time to swallowing was 18.0 days. Fourteen of 16 patients (93%) were able to rely on TEP speech as their main modality of communication. Two patients (8%) had early fistulas develop, and 5 (20%) had late fistulas develop. Nine patients (36%) required mechanical dilatation; five of the nine patients required only one dilatation.
Review of our experience has confirmed the reliability and excellent functional outcome associated with this flap.
晚期下咽癌患者必须应对生存预后可能较差以及剩余生活质量受损的问题。在进行广泛的切除手术后，必须采用可靠且发病率低的重建策略，以便能迅速恢复言语和吞咽功能。
回顾性分析1996年至2001年间由同一位外科医生（RE）使用桡侧前臂游离皮瓣（RFFF）进行咽食管重建的28例患者的记录。分析仅限于需要对RFFF进行完全管状化的患者。分析围手术期死亡率、发病率，并基于言语和吞咽参数进行功能评估。
25例患者需要完全管状化的RFFF。RFFF存活率为100%，无围手术期死亡病例。中位住院时间为8.0天。所有患者均恢复了经口进食；吞咽的中位时间为18.0天。16例患者中有14例（93%）能够依靠食管发音假体（TEP）言语作为主要交流方式。2例患者（8%）发生早期瘘，5例患者（20%）发生晚期瘘。9例患者（36%）需要进行机械扩张；9例患者中有5例仅需进行一次扩张。
对我们经验的回顾证实了该皮瓣的可靠性和出色的功能结果。
