Cusumano R J, Silver C E, Brauer R J, Strauch B
Department of Head and Neck Surgery, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York 10467.
Head Neck. 1989 Sep-Oct;11(5):450-6. doi: 10.1002/hed.2880110512.
The authors report experience with 10 cases of pharyngoesophageal replacement with tubed pectoralis major myocutaneous (PM) flap. Six patients had primary reconstruction following total pharyngolaryngectomy for cancer; the other 4 had severe pharyngoesophageal stenosis requiring resection and replacement following previous laryngectomy. Seven of the patients were octogenarians, 6 had been irradiated previously, and all were severely debilitated. Two patients died postoperatively of cardiac disease. The remaining eight regained satisfactory with lasting deglutition. Four fistulae healed spontaneously, and one postoperative stenosis responded to a single dilitation. The interval to swallowing was 10-21 days in nonirradiated patients and 3-13 weeks in irradiated patients. There was one local recurrence 6 months after resection; the other patients remained free of disease. The authors conclude that the tubed PM flap is a reliable technique for pharyngoesophageal reconstruction that is particularly useful in elderly and debilitated patients.
作者报告了10例采用管状胸大肌肌皮瓣（PM瓣）进行咽食管重建的经验。6例患者因癌症行全喉咽切除术，术后进行一期重建；另外4例患者曾行喉切除术，因严重的咽食管狭窄需行切除及重建。其中7例患者为八旬老人，6例曾接受过放疗，且均身体极度虚弱。2例患者术后死于心脏病。其余8例患者吞咽功能恢复良好且持久。4例瘘口自愈，1例术后狭窄经单次扩张后缓解。未接受放疗的患者吞咽间隔时间为10 - 21天，接受放疗的患者为3 - 13周。切除术后6个月有1例局部复发；其他患者无疾病复发。作者得出结论，管状PM瓣是一种可靠的咽食管重建技术，对老年及身体虚弱的患者尤为有用。
