Division of Plastic and Reconstructive Surgery, National Cancer Center Hospital East, Kashiwa, Japan.
Laryngoscope. 2011 May;121(5):947-51. doi: 10.1002/lary.21742.
OBJECTIVES/HYPOTHESIS: The objective of this retrospective study was to examine the safety and efficacy of free jejunum transfer after total pharyngolaryngectomy after radiotherapy (RT) or chemoradiotherapy (CRT) to the neck for patients with recurrent or second primary disease.
Retrospective study.
A total of 313 patients were divided into two groups on the basis of a history of RT to the neck: 86 patients had received RT and 227 patients had not. The patients who had received RT were subdivided on the basis of the type of previous treatment: those who had received RT alone (32 patients) and those who had undergone concurrent CRT (54 patients). Postoperative complications were compared between RT and non-RT groups and between the RT-alone and CRT groups.
The rates of complications did not differ significantly between the RT and non-RT groups, but the rates of anastomotic thrombosis and carotid rupture were slightly but not significantly higher in the RT group than in the non-RT group. The overall complication rate did not differ between the RT-alone group and the CRT group.
Pharyngolaryngectomy and free jejunum transfer can be performed safely, even in patients who have received RT, without significant increases in morbidity or mortality. However, a risk of carotid rupture due to pharyngocutaneous fistula remains in patients who have received RT, and prevention and early detection of fistulas are crucial. The risk of postoperative complications is not higher with CRT than with RT alone.
目的/假设：本回顾性研究的目的是研究在接受颈部放疗（RT）或放化疗（CRT）后复发性或第二原发疾病患者中，全咽喉切除术后游离空肠转移的安全性和有效性。
回顾性研究。
根据颈部 RT 史，将 313 例患者分为两组：86 例患者接受 RT，227 例患者未接受 RT。接受 RT 的患者根据既往治疗方式分为单纯 RT 组（32 例）和同期 CRT 组（54 例）。比较 RT 组和非 RT 组、单纯 RT 组和 CRT 组之间的术后并发症。
RT 组与非 RT 组的并发症发生率无显著差异，但 RT 组吻合口血栓和颈动脉破裂的发生率略高于非 RT 组，但无统计学意义。单纯 RT 组和 CRT 组的总并发症发生率无差异。
即使在接受 RT 的患者中，咽喉切除和游离空肠转移也可以安全进行，不会显著增加发病率或死亡率。然而，接受 RT 的患者由于咽皮瘘仍然存在颈动脉破裂的风险，预防和早期发现瘘管至关重要。与单纯 RT 相比，CRT 术后并发症的风险并不更高。
