Zhang Bin, Tang Ping-Zhang, Xu Zhen-Gang, Qi Yong-Fa, Li De-Zhi, Zhang Zongmin
Department of Head and Neck Surgery, Cancer Hospital, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing 100021, China.
Zhonghua Er Bi Yan Hou Ke Za Zhi. 2004 Jul;39(7):419-24.
To choose the optimal reconstruction for circumferential defects of the hypopharynx between pharyngogastric anastomosis and free jejunal interposition is.
Retrospective review of the archives of 125 patients who underwent pharyngoesophageal reconstruction with pharyngogastric anastomosis(n = 92) or free jejunal interposition(n = 33). Analysis was confined to patient with advanced hypopharyngeal cancer or recurrent laryngeal cancer who had hypopharyngeal circumferential defects after tumor ablation.
The morbidity and mortality associated with reconstructive procedures were significantly higher in the pharyngogastric anastomosis group than in the free jejunal interposition group (43% versus 21%, P = 0.023 and 11% versus 0%, P = 0. 048). The risk factors related to complications associated with the procedures were reconstruction with pharyngogastric anastomosis (OR 2.97; 95% CI 1.14; 7.76) and albumin < 40.0 g/L(OR 2.87; 95% CI 1.33; 6.16) . The occurrence of swallow obstruction or regurgitation was higher in the pharyngogastric anastomosis group than in the free jejunal interposition group(76% versus 12%, P = 0.00). Patients in the pharyngogastric anastomosis group had lost weight of 3.3 kg (95% CI - 5.7; - 1.0) postoperatively, on the contrary, patients in the free jejunal interposition group had gained weight of 2.8 kg(95% CI 0.9; 4.7) postoperatively.
Patients reconstructed with free jejunal interposition had lower mortality and complications than with pharyngogastric anastomosis. Furthermore, the former seems to have better quality of life than the latter. The first choice of reconstructive strategy for hypopharyngeal circumferential defects is free jejunal interposition.
比较咽胃吻合术和游离空肠移植术对下咽环形缺损修复的效果，选择最佳修复方式。
回顾性分析125例行咽食管重建术患者的资料，其中92例行咽胃吻合术，33例行游离空肠移植术。分析对象仅限于晚期下咽癌或复发性喉癌患者，这些患者在肿瘤切除后存在下咽环形缺损。
咽胃吻合术组重建手术相关的发病率和死亡率显著高于游离空肠移植术组（分别为43%对21%，P = 0.023；11%对0%，P = 0.048）。与手术相关并发症的危险因素为咽胃吻合术重建（比值比2.97；95%可信区间1.14；7.76）和白蛋白<40.0 g/L（比值比2.87；95%可信区间1.33；6.16）。咽胃吻合术组吞咽梗阻或反流的发生率高于游离空肠移植术组（76%对12%，P = 0.00）。咽胃吻合术组患者术后体重减轻3.3 kg（95%可信区间-5.7；-1.0），相反，游离空肠移植术组患者术后体重增加2.8 kg（95%可信区间0.9；4.7）。
游离空肠移植术重建的患者比咽胃吻合术患者死亡率和并发症更低。此外，前者的生活质量似乎优于后者。下咽环形缺损修复策略的首选是游离空肠移植术。
