Grillo H C, Mathisen D J
Division of Thoracic Surgery, Massachusetts General Hospital, Harvard Medical School, Boston 02114.
Ann Thorac Surg. 1990 Mar;49(3):401-8; discussion 408-9. doi: 10.1016/0003-4975(90)90243-y.
Cervical exenteration is a radical operation to remove the larynx, portion of the trachea, and the esophagus, and frequently requires a mediastinal tracheostomy. Highly selected patients with obstructing neoplasms of the esophagus and airway can be palliated and sometimes cured by this aggressive surgical approach. Fatal hemorrhage from pressure or exposure of the innominate artery is avoided by elective division of the artery (preoperative angiograms and intraoperative electroencephalographic control are essential), using the omentum to separate the trachea and great vessels, and removal of a bony plaque of chest wall to allow a well-vascularized bipedicled skin flap to drop into the mediastinum for the tracheocutaneous anastomosis. Eighteen exenterations were performed. Mediastinal tracheostomy was performed in 14 patients and division of the innominate artery was performed in 7. Esophageal replacement was predominantly with the left colon. Complications include esophageal leak (2 patients), stomal separation (2), transient hemiplegia (1), colonic obstruction by substernal tunnel (1), and need for prolonged mechanical ventilation (4). There was a single operative death. Postoperative survival was disease dependent. All patients achieved an excellent airway and relief from dysphagia.
颈清扫术是一种切除喉、部分气管和食管的根治性手术，通常需要进行纵隔气管造口术。经过严格筛选的患有食管和气道阻塞性肿瘤的患者，通过这种积极的手术方法可以得到姑息治疗，有时甚至可以治愈。通过选择性地切断无名动脉（术前血管造影和术中脑电图监测至关重要）、使用大网膜分离气管和大血管以及切除胸壁的骨板，使血运丰富的双蒂皮瓣落入纵隔进行气管皮肤吻合，可避免因无名动脉受压或暴露导致的致命性出血。共进行了18例清扫术。14例患者进行了纵隔气管造口术，7例进行了无名动脉切断术。食管重建主要采用左结肠。并发症包括食管漏（2例）、吻合口裂开（2例）、短暂性偏瘫（1例）、胸骨后隧道导致的结肠梗阻（1例）以及需要长时间机械通气（4例）。有1例手术死亡。术后生存率取决于疾病情况。所有患者的气道均良好，吞咽困难得到缓解。
