Germain M A, Trotoux J, Luboinski B, Wibault P, Demers G
Service de Chirurgie, Hôpital Max Fourestier, Nanterre.
Bull Acad Natl Med. 1995 Jan;179(1):147-56; discussion 156-7.
One hundred and ninety seven patients with cancer of the hypopharynx underwent after circular resection, reconstruction with a free jejunal graft. The quality of free jejunal grafts is controlled by many investigations: clinical examination, radiography, electromyography, fibroscopy with biopsy. These investigations show that technically jejunal grafts must be short and linear to give the best functional results. Average resumption of oral intake was 14 days. Oral feeding was possible in 92% of cases. The free jejunal grafts with microsurgery are one of the more reliable procedures for reconstruction of pharynx and cervical esophagus after resection for cancer. (2 post-operative deaths and 8 grafts necrosis on 197 cases). The cumulative survival rate of 5 years was 35% for free jejunal graft. Survival depends on selection of the patients for local and nodes invasion. The quality of survival has improved. This operation must be reserved for the hypopharyngeal cancers which need a circular resection and do not invade the esophagus. The surgery is performed for a curative aim. The distant follow up of the patients is imperative: consultation every four months and then every six months: clinical examination, endoscopic, E.N.T., bronchial, and esophageal investigation. Chemotherapy and radiotherapy have specific indications.
197例下咽癌患者在环状切除术后，采用游离空肠移植进行重建。游离空肠移植的质量通过多项检查来控制：临床检查、放射照相、肌电图、带活检的纤维镜检查。这些检查表明，从技术上讲，空肠移植必须短且呈直线状，才能取得最佳功能效果。平均经口进食恢复时间为14天。92%的病例能够经口进食。游离空肠移植显微手术是下咽和颈段食管切除术后重建较为可靠的手术方法之一。（197例中有2例术后死亡，8例移植坏死）。游离空肠移植5年累积生存率为35%。生存率取决于对局部和淋巴结侵犯患者的选择。生存质量有所提高。该手术必须仅用于需要环状切除且未侵犯食管的下咽癌。手术以治愈为目的。必须对患者进行长期随访：每四个月然后每六个月进行一次会诊：临床检查、内镜检查、耳鼻喉科检查、支气管检查和食管检查。化疗和放疗有特定指征。
