Silver C E, Cusumano R J, Fell S C, Strauch B
Department of Head and Neck Surgery, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY 10467.
Laryngoscope. 1989 Aug;99(8 Pt 1):819-21. doi: 10.1288/00005537-198908000-00009.
The authors reviewed 25 cases of pharyngoesophageal replacement. A tubed pectoralis major myocutaneous flap was employed in ten cases where an adequate distal resection margin could be obtained above the thoracic inlet. Total gastric transposition was used in 15 cases where resection extended into the mediastinum. The overall rates of complications (52%), postoperative mortality (20%), and satisfactory deglutition (80%) were similar for both operations and were superior to those achieved with reconstructive procedures previously used by the authors. The choice of method is influenced by the length of the pharyngoesophagus to be replaced and the general condition of the patient. Gastric transposition is a more versatile operation and is adaptable to replacement of the entire esophagus if necessary, while the tubed pectoralis major myocutaneous flap has proven particularly effective for the rehabilitation of elderly and severely debilitated patients.
作者回顾了25例咽食管置换病例。10例在胸廓入口上方能够获得足够远切缘的患者采用了管状胸大肌肌皮瓣。15例切除范围延伸至纵隔的患者采用了全胃转位术。两种手术的总体并发症发生率（52%）、术后死亡率（20%）和吞咽满意率（80%）相似，且优于作者之前使用的重建手术。手术方法的选择受待置换咽食管的长度和患者一般状况的影响。胃转位术是一种更具通用性的手术，如有必要可适用于整个食管的置换，而管状胸大肌肌皮瓣已被证明对老年和严重虚弱患者的康复特别有效。
