Chen Hung-Chi, Ciudad Pedro, Chen Shih-Heng, Agko Mouchammed
Department of Plastic and Reconstructive Surgery, China Medical University Hospital, Taichung, Taiwan.
Department of Biological Science and Technology, China Medical University, Taichung, Taiwan.
J Surg Oncol. 2018 Mar;117(3):459-468. doi: 10.1002/jso.24864. Epub 2017 Nov 1.
Several surgical options exist for the reconstruction of total pharyngolaryngectomy defect. The purpose of this report is to present our experience with ileocolon flap for simultaneous reconstruction of both esophagus and voice.
Demographic data, clinical information, and outcomes of 205 patients who underwent the ileocolon flap procedure over the last 35 years were examined. Preoperative evaluation, intraoperative details, and postoperative management were analyzed. The types of additional procedures performed to improve outcomes were explored.
Of the 205 patients, 191 had a free ileocolon flap and the remaining 14 a pedicled flap. Ninety-seven percent of the flaps were successful with a fistula rate of 5.4%. Seven patients required reexploration and six flaps failed. Seventy-eight percent of the patients reported their swallowing function to be very good to excellent. Speech function was rated as good in 64% of patients and moderate in 21%. Three patients develop bowel obstruction, two of which required enterolysis. Five patients had postoperative diarrhea that responded to conservative measures.
Reconstruction of pharyngoesophageal defects with ileocolon flap permits resumption of swallowing and production of speech without the need for voice prosthesis and with minimal complications.
全喉咽切除术缺损的重建有多种手术选择。本报告的目的是介绍我们使用回结肠瓣同时重建食管和嗓音的经验。
对过去35年中接受回结肠瓣手术的205例患者的人口统计学数据、临床信息和结果进行了检查。分析了术前评估、术中细节和术后管理。探讨了为改善结果而进行的其他手术类型。
205例患者中，191例采用游离回结肠瓣，其余14例采用带蒂瓣。97%的瓣成功，瘘发生率为5.4%。7例患者需要再次手术探查，6个瓣失败。78%的患者报告吞咽功能非常好至优秀。64%的患者语音功能评为良好，21%评为中等。有3例患者发生肠梗阻，其中2例需要进行肠粘连松解术。5例患者术后出现腹泻，经保守治疗后好转。
用回结肠瓣重建喉咽食管缺损可恢复吞咽和发声功能，无需使用发音假体，并发症极少。
