Li W Y, Wang J, Yang D H, Huo H, Jin X F, Niu Y Y
Department of Otorhinolaryngology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College.
Lin Chuang Er Bi Yan Hou Tou Jing Wai Ke Za Zhi. 2016 Dec;30(24):1913-1917. doi: 10.13201/j.issn.1001-1781.2016.24.004.
To describe the therapeutic effect of transoral endoscopic minimally invasive surgery for hypopharyngeal postcricoidarea and upper esophageal lesions. Transoral endoscopic minimally invastive surgery was carried out in fifteen patients.There were 7 patients with primary tumors on the postcricoid area, including three squamous cell carcinoma(2 cases T2N0M0,1 case T2N2cM0),two cavernous hemangioma, one giant fibrovascular polyp and one recurrent lipofibroma. The transoral endoscopic tumors resection en bloc was performed in all of them. Adjuvant postoperative radiation therapy was applied in cases of cancer, and bilateral neck dissections was performed in the T2N2cM0 case; There were other eight patients with upper esophageal lesions , seven cases dysphagia was caused by stroke and one case was Zenker diverticulum, treated by endoscopic cricopharyngeal myotomy ordiverticulotomy. The en bloc resection endoscopically was achieved in all of patients with tumors on the postcricoid area. All surgical resection margins were negative.The two cases of postcricoid cancer and four benign tumor were followed up 16-30 months and 2-12 months respectively, and all of the cases were not local recurrence. A recent patient with postcricoid cancer had not finished postoperative adjuvant radiation therapy. The endoscopic cricopharyngeal myotomy was effective in 4 out of 7 patients,nasogastric feeding was no longer required.Significant improvement occurred in Zenker diverticulotomy patient, due to the return of physiological deglutition, and Barium swallow study showing disappearance of the diverticulum after one month.The effects of minimally invasive threatment were satisfactory,such as not need tracheotomy and early oral feeding, shorter hospital stay and less postoperative complications. Transoral endoscopic surgery is minimally invastive, safe and effective treatment alternative for some hypopharyngeal postcricoid area and upper esophageal lesions.
描述经口内镜微创手术治疗下咽环状软骨后区及食管上段病变的疗效。对15例患者实施经口内镜微创手术。环状软骨后区原发性肿瘤患者7例,其中3例为鳞状细胞癌(2例T2N0M0,1例T2N2cM0),2例为海绵状血管瘤,1例为巨大纤维血管息肉,1例为复发性脂肪纤维瘤。所有患者均行内镜下肿瘤整块切除。癌症患者术后行辅助放疗,T2N2cM0患者行双侧颈清扫术;其他8例食管上段病变患者,7例吞咽困难由中风引起,1例为Zenker憩室,均行内镜下环咽肌切开术或憩室切除术。环状软骨后区肿瘤患者均实现内镜下整块切除。所有手术切缘均为阴性。2例环状软骨后区癌患者和4例良性肿瘤患者分别随访16 - 30个月和2 - 12个月,均无局部复发。1例近期环状软骨后区癌患者尚未完成术后辅助放疗。内镜下环咽肌切开术在7例患者中有4例有效,不再需要鼻饲。Zenker憩室切除术患者有显著改善,吞咽生理功能恢复,钡餐检查显示1个月后憩室消失。微创手术效果满意,如无需气管切开、早期经口进食、住院时间短、术后并发症少。经口内镜手术是治疗部分下咽环状软骨后区及食管上段病变的微创、安全、有效的治疗方法。