Division of Head and Neck Surgery, Department of Surgery, University of Hong Kong Li Ka Shing Faculty of Medicine, Queen Mary Hospital, 102 Pokfulam Road, Hong Kong SAR, China.
J Plast Reconstr Aesthet Surg. 2011 Aug;64(8):1022-8. doi: 10.1016/j.bjps.2011.03.021. Epub 2011 Apr 11.
Reconstruction of circumferential hypopharyngeal defects is often challenging. The aim of the study is to examine the result of our experience and to formulate improved management guidelines.
Between 1980 and 2009, all patients who have circumferential pharyngectomy were recruited. Data were recorded prospectively for analysis.
A total of 202 patients were recruited. Majority had primary tumour in the hypopharynx (n=165), and the remaining patients had recurrent laryngeal carcinoma. Radiotherapy was given preoperatively in 72 patients and postoperatively in 108 patients. A pectoralis major (PM) flap was used in 92 (45.5%) patients, a free anterolateral thigh (ALT) flap in 24 (11.9%) patients and a free jejunal flap in 86 (42.6%) patients. Early fistula rate was 23.9% in the PM flap group, 12.5% in the ALT group and 4.6% in the jejunum group. Late anastomotic stricture rate was 27.2% in the PM flap group, 12.5% in the free ALT group and 2.3% in the jejunum group. Early fistula formation significantly increased the risk of subsequent anastomotic stricture (p=0.023). In patients with no stricture, 61.9% of them in the jejunal group were able to resume solid diet, compared with 35.8% and 38.1% in the PM and ALT groups. After PM flap harvesting, 34.8% of the chest wall defects could not be closed primarily, which were best repaired using the lateral thoracic flap. The donor-site morbidity of ALT and jejunal flap was low.
In suitable patients, free jejunal flap reconstruction of circumferential pharyngectomy defects achieves the best functional outcome with minimal donor-site morbidity.
环状下咽缺损的重建常常具有挑战性。本研究旨在评估我们的经验，并制定出改良的管理指南。
1980 年至 2009 年间，所有接受环状咽切除术的患者均被纳入研究。前瞻性地记录数据并进行分析。
共纳入 202 例患者。大多数患者的原发肿瘤位于下咽（n=165），其余患者为复发性喉癌。72 例患者术前接受放疗，108 例患者术后接受放疗。92 例（45.5%）患者使用胸大肌皮瓣，24 例（11.9%）患者使用游离股前外侧皮瓣，86 例（42.6%）患者使用游离空肠瓣。胸大肌皮瓣组早期瘘的发生率为 23.9%，游离股前外侧皮瓣组为 12.5%，游离空肠瓣组为 4.6%。胸大肌皮瓣组晚期吻合口狭窄的发生率为 27.2%，游离股前外侧皮瓣组为 12.5%，游离空肠瓣组为 2.3%。早期瘘的形成显著增加了随后吻合口狭窄的风险（p=0.023）。在无狭窄的患者中，空肠组有 61.9%的患者可以恢复固体饮食，而胸大肌皮瓣组和游离股前外侧皮瓣组分别为 35.8%和 38.1%。胸大肌皮瓣切取后，34.8%的胸壁缺损无法直接缝合，最好用侧胸皮瓣修复。游离股前外侧皮瓣和空肠瓣的供区并发症发生率较低。
在合适的患者中，游离空肠瓣重建环状下咽缺损可获得最佳的功能效果，且供区并发症发生率最低。
