Coleman J J
Division of Plastic Surgery, Indiana University Medical School, Indianapolis 46202-5124, USA.
Semin Surg Oncol. 1995 May-Jun;11(3):208-20. doi: 10.1002/ssu.2980110306.
The recent twenty years have brought major advances in reconstruction of pharyngoesophageal defects. Early dependence on multiple staged procedures initially were replaced by colon interposition and gastric pull-up. Subsequent elucidation of the musculocutaneous concept has added useful techniques such as the sternocleidomastoid and pectoralis major musculocutaneous flaps. Increasing experience with microsurgical reconstruction and a larger number of flaps available have made free tissue transfer a common and reliable method of reconstruction of significant defects. The choice of reconstruction depends to greatest degree on the oncologic needs of the situation. If the entire esophagus or significant part of the thoracic esophagus is involved by tumor then total esophagectomy and gastric pull-up or colon interposition is indicated. For most hypopharyngeal and laryngopharyngeal tumors, and a significant number of cervical esophageal tumors, segmental resection of the area with the appropriate node dissection and replacement with a jejunal free autograft or radial forearm free flap gives a high likelihood of success. Thoracic musculocutaneous flaps may be useful if proper precautions are observed in the reconstructive technique. This article presents the accumulated experience with these techniques and management of the subsequent problems.
最近二十年来，咽食管缺损重建取得了重大进展。早期对多阶段手术的依赖最初被结肠间置术和胃上提术所取代。随后对肌皮瓣概念的阐明增加了有用的技术，如胸锁乳突肌和胸大肌肌皮瓣。显微外科重建经验的增加以及可用皮瓣数量的增多，使得游离组织移植成为重建重大缺损的常用且可靠的方法。重建方式的选择在很大程度上取决于具体情况的肿瘤学需求。如果整个食管或胸段食管的大部分被肿瘤累及，则需行全食管切除术并进行胃上提术或结肠间置术。对于大多数下咽和喉咽肿瘤以及大量颈段食管肿瘤，对该区域进行节段性切除并进行适当的淋巴结清扫，然后用空肠游离自体移植或桡侧前臂游离皮瓣进行替代，成功的可能性很高。如果在重建技术中采取适当的预防措施，胸段肌皮瓣可能会有用。本文介绍了这些技术的积累经验以及后续问题的处理方法。
