Stepnick D W, Hayden R E
Case Western Reserve University School of Medicine, Cleveland, Ohio.
Otolaryngol Clin North Am. 1994 Dec;27(6):1151-8.
Reconstruction of the circumferential pharyngoesophageal defect and functional rehabilitation of swallowing after cancer ablation remain a challenge for head and neck surgeons. A variety of techniques have been described, four of which have particular merit. The following general guidelines can be utilized when selecting a reconstructive technique. The pectoralis major myocutaneous flap can be used when pharyngeal mucosa remains following cancer resection or by surgeons who do not perform microvascular free tissue transfer to reconstruct circumferential defects. Gastric pull-up should be used if significant extension of tumor into the esophagus is present, oncologically necessitating esophagectomy. Free jejunal flaps are particularly useful in obese patients or patients in whom the lateral cutaneous thigh flap is otherwise contraindicated. The lateral thigh flap gives excellent results, has low morbidity, and causes virtually no functional impairment at the donor site. We believe that it represents state of the art in pharyngoesophageal reconstruction.
癌症切除术后环周性咽食管缺损的重建及吞咽功能康复仍是头颈外科医生面临的一项挑战。已描述了多种技术，其中四种具有特别的优势。选择重建技术时可采用以下一般准则。当癌切除术后咽黏膜仍存在时，或对于不进行微血管游离组织移植以重建环周缺损的外科医生而言，可使用胸大肌肌皮瓣。如果肿瘤明显侵犯食管，从肿瘤学角度需要进行食管切除术，则应采用胃上提术。游离空肠瓣在肥胖患者或禁忌使用股外侧皮瓣的患者中特别有用。股外侧皮瓣效果极佳，发病率低，且供区几乎不造成功能障碍。我们认为它代表了咽食管重建的先进水平。
