Loré J M, Klotch D W, Lee K Y
Am J Surg. 1982 Oct;144(4):473-6. doi: 10.1016/0002-9610(82)90427-5.
Reconstruction of the hypopharynx following total laryngectomy and total pharyngectomy provides a one-stage procedure to reconstitute the food conduit. A myomucosal advancement tongue flap forms the anterolateral walls, and the dermal graft forms the posterior wall of the reconstruction. Sixteen patients underwent reconstruction by this method. Thirteen required total laryngectomy and total pharyngectomy for extensive carcinomas. Two other patients who had previous laryngectomy and hypopharyngeal recurrence had pharyngectomy and repair by tongue flap and dermal graft. A third patient required laryngopharyngectomy following recurrence after supraglottic laryngectomy. No postoperative deaths have occurred. Anteriolateral defects of up to 8 cm in size can be reconstructed providing the neck can be flexed. Larger posterior defects superior to the eustachian tube can be closed. In two patients minor fistulas developed which closed spontaneously. One other patient had a delayed wound dehiscence and infection with fistula and carotid blowout. The patient had undergone previous surgery and radiotherapy. Deglutition was good to excellent in most patients. Three patients required esophageal dilatation with resolution. Cinegraphic studies have demonstrated the tongue to propel a bolus and to modulate speech which shows this repair to create a dynamic conduit. One patient had difficulty in swallowing because the left hypoglossal nerve was resected. Seven patients were alive with no evidence of disease 2 to 30 months postoperatively. Four patients who were free of their original disease died from other causes. Four patients died from original disease 5 to 23 months postoperatively. At present, one patient is alive with disease. Tongue flap and dermal graft provide a reliable and one-stage reconstruction following laryngopharyngectomy and should be considered as an alternative to distant flap and intestinal interposition reconstructive procedures.
全喉切除和全咽切除术后下咽重建提供了一种一期重建食物通道的手术方法。肌黏膜推进舌瓣形成前外侧壁，真皮移植片形成重建物的后壁。16例患者采用该方法进行重建。13例因广泛癌肿而行全喉切除和全咽切除。另外2例曾行喉切除且下咽复发的患者接受了咽切除并采用舌瓣和真皮移植片修复。第3例患者在声门上喉切除术后复发，需行喉咽切除。术后无死亡病例。只要颈部能够屈曲，大小达8 cm的前外侧缺损均可重建。高于咽鼓管的较大后壁缺损能够闭合。2例患者出现小瘘口，均自行愈合。另1例患者伤口延迟裂开并感染形成瘘口，伴颈动脉破裂。该患者曾接受过手术和放疗。大多数患者吞咽功能良好至极佳。3例患者需行食管扩张，扩张后症状缓解。动态造影研究显示，舌可推动食团并调节语音，表明这种修复形成了一个动态通道。1例患者因左侧舌下神经被切除而吞咽困难。7例患者术后2至30个月存活，无疾病证据。4例已摆脱原发病的患者死于其他原因。4例患者术后5至23个月死于原发病。目前，1例患者带瘤存活。舌瓣和真皮移植片为喉咽切除术后提供了一种可靠的一期重建方法，应被视为远位皮瓣和肠管移植重建手术的替代方法。
