Chen Wenhe, Peng Hanwei
Lin Chuang Er Bi Yan Hou Tou Jing Wai Ke Za Zhi. 2013 Nov;27(21):1163-6, 1170.
To explore the principles of donor site selection for defects of the hypopharynx and/or cervical-esophagus based on a novel defect classification system and treatment outcome of this series.
Thirty-nine patients underwent reconstruction of their defects of the hypopharynx and/or cervical-esophagus from January 2007 to June 2012 were retrospectively studied. 23 hypopharngeal and/or cervical-esophageal defects were circumferential or near circumferential (group A), 16 were partial(group B). 22 patients had compromised neck vascular status, while the other 17 patients had normal neck vascular status. Selection of the donor sites was based on extent of the defects and neck vascular status. Donor sites for reconstruction of the defects of group A included anterolateral thigh flap (n = 8), gastric pull-up (n = 6), radial forearm flap (n = 3), jejunum flap (n = 3), and pectoralis major myocutaneous flap (n = 3). For goup B, Infrahyoid myocutaceous flaps, radial forearm flaps, and pectoralis major myocutaneous flaps were used in 8, 3, and 5 cases, respectively. Flap survival, surgical complications, function outcome, and tumor control were observed.
Overall complication rate was 12.8% (5/39) in this series. In group A, three flap necroses occurred in jejunum flap (n = 1), anterolateral thigh flap (n = 1), and pectoralis major flap (n = 1). All these flap necroses occurred in the compromised neck vascular status group. One case of pharyngeal fistula without flap necrosis occurred in Group B. All except 2 patients restored oral intake postoperatively; 16 patients with laryngeal preservation had good phonation postoperatively. 2-year and 3-year survival of this series were 72.1% and 65.2%, respectively.
Selection of an appropriate donor site for reconstruction of the defects of hypopharynx and /or cervical-esophagus should be based on the extent of the defects, neck vascular status, and clinical features of the flap. Individualized donor site selection for hypopharyngeal and cervical esophageal defects reconstruction can result in good clinical outcome.
基于一种新的缺损分类系统及本系列的治疗结果，探讨下咽和/或颈段食管缺损供区选择的原则。
回顾性研究2007年1月至2012年6月间39例行下咽和/或颈段食管缺损重建术的患者。23例下咽和/或颈段食管缺损为环形或近环形（A组），16例为部分缺损（B组）。22例患者颈部血管状况不佳，其余17例患者颈部血管状况正常。供区的选择基于缺损范围和颈部血管状况。A组缺损重建的供区包括股前外侧皮瓣（8例）、胃上提术（6例）、桡骨前臂皮瓣（3例）、空肠皮瓣（3例）和胸大肌肌皮瓣（3例）。对于B组，分别有8例、3例和5例使用了舌骨下肌皮瓣、桡骨前臂皮瓣和胸大肌肌皮瓣。观察皮瓣存活情况、手术并发症、功能结果和肿瘤控制情况。
本系列的总体并发症发生率为12.8%（5/39）。在A组中，空肠皮瓣（1例）、股前外侧皮瓣（1例）和胸大肌皮瓣（1例）发生了3例皮瓣坏死。所有这些皮瓣坏死均发生在颈部血管状况不佳的组中。B组发生1例无皮瓣坏死的咽瘘。除2例患者外，所有患者术后均恢复经口进食；16例保留喉的患者术后发声良好。本系列的2年和3年生存率分别为72.1%和65.2%。
下咽和/或颈段食管缺损重建供区的选择应基于缺损范围、颈部血管状况和皮瓣的临床特点。下咽和颈段食管缺损重建的个体化供区选择可带来良好的临床效果。
