London, United Kingdom From the Departments of Plastic and Reconstructive Surgery, Ear, Nose and Throat Surgery, Radiology, and Speech and Language Therapy, Charing Cross Hospital, and the Kennedy Institute of Rheumatology, Imperial College.
Plast Reconstr Surg. 2010 Dec;126(6):1960-1966. doi: 10.1097/PRS.0b013e3181f446a6.
Reconstruction following pharyngolaryngectomy presents a complex reconstructive challenge, and a single-stage, reliable reconstruction allowing prompt discharge from the hospital and return of swallowing and speech function is required. The authors present their 10-year experience of 43 jejunal free flaps for pharyngolaryngectomy reconstruction by a single team and outline their operative algorithm to minimize postoperative morbidity.
The data for patients who underwent jejunal free flap reconstruction of circumferential pharyngoesophageal defects between March of 2000 and September of 2009 were reviewed retrospectively. All cases were included for analysis.
There were 31 male patients and 12 female patients, with 100 percent acute flap survival. The authors' overall benign pharyngocutaneous fistula rate was two of 43 (5 percent), with two of 29 (7 percent) occurring in the group without a prophylactic pectoralis muscle flap and zero of 14 occurring in the group that had a prophylactic pectoralis muscle flap. No fistulas occurred when the anastomosis was performed with the gastrointestinal stapler (zero of 48). The authors' overall benign stricture rate was six of 43 (14 percent). Thirty-six patients received either a primary or secondary tracheoesophageal puncture; of these, 28 of 36 (78 percent) used their tracheoesophageal puncture as their primary mode of communication.
The authors' recommendations for minimizing fistulas and stricture rate, following free jejunal reconstruction, include the gastrointestinal stapler for bowel anastomosis whenever possible, and the use of a prophylactic pedicled pectoralis major muscle flap for patients exposed to previous radiotherapy.
咽喉切除术的重建提出了一个复杂的重建挑战，需要一种能够在单一阶段进行可靠重建、允许患者迅速出院并恢复吞咽和言语功能的方法。作者介绍了他们由一个团队实施的 10 年来 43 例空肠游离皮瓣用于咽喉切除术重建的经验，并概述了他们的手术算法，以最大限度地减少术后发病率。
回顾性分析了 2000 年 3 月至 2009 年 9 月期间接受空肠游离皮瓣重建环状咽食管缺损的患者数据。所有病例均纳入分析。
31 例男性患者和 12 例女性患者，急性皮瓣存活率为 100％。作者总的良性咽皮瘘发生率为 43 例中的 2 例（5％），其中 2 例（7％）发生在未预防性使用胸大肌皮瓣的组中，而 14 例中有 0 例（0％）发生在预防性使用胸大肌皮瓣的组中。吻合时使用胃肠吻合器（48 例中无 0 例）不会发生瘘管。作者总的良性狭窄发生率为 43 例中的 6 例（14％）。36 例患者接受了原发性或继发性气管食管造口术；其中，36 例中的 28 例（78％）将气管食管造口术作为其主要交流方式。
为了最大限度地减少空肠游离重建后瘘管和狭窄的发生率，作者建议尽可能使用胃肠吻合器进行肠吻合，并对接受过放疗的患者使用预防性带蒂胸大肌肌皮瓣。
