Lont H E, van Lanschot J J, Hop W C, Eijkenboom W M, Knegt P P, Tilanus H W
Afd. Algemene Heelkunde, Academisch Ziekenhuis Rotterdam-Dijkzigt.
Ned Tijdschr Geneeskd. 1994 Jun 25;138(26):1317-21.
To evaluate the results of pharyngo-oesophageal reconstruction after pharyngolaryngectomy using a free jejunal interposition graft.
Retrospective study.
University Hospital Dijkzigt, Rotterdam.
Between 1982 and 1992, 59 selected patients (median age 63 years) undergoing laryngopharyngectomy for cancer had the continuity of the upper gastrointestinal tract restored by use of a free jejunal autograft. Twenty-three (36%) had had no previous treatment and received post-operative radiotherapy. Eight patients had laryngeal tumour recurrence after irradiation and in 28 (48%) patients pre-operative radiotherapy had been administered.
Follow-up ranged from 1-127 months (mean 37 months). Graft necrosis secondary to vascular problems initially occurred in 5 patients. In four cases the jejunum was successfully replaced by another segment and in one patient a gastric transposition was performed. Fistulas occurred in eight patients of whom four required surgery. The mortality rate was 8.5%. After discharge 6 patients were reoperated on for dysphagia due to stricture formation. In four cases the distal or proximal anastomosis was revised and in the other two patients the graft was replaced, by another segment and by a colonic autograft, respectively. One year after operation 85% of the patients reported an adequate swallowing function and a normal oral intake. The overall 5-year survival rate of this selected group of patients was 42%, for those without primary lymph node involvement 66%. All patients with primary locoregional metastasis died within a period of 34 months after operation.
Reconstruction of the upper alimentary tract after a laryngopharyngectomy with a free jejunal autograft appears to be a relatively safe procedure with an acceptable mortality and morbidity and, in patients without local lymph node involvement, good long-term results.
评估采用游离空肠移植术进行喉咽切除术后咽食管重建的效果。
回顾性研究。
鹿特丹迪克齐希特大学医院。
1982年至1992年间，59例因癌症接受喉咽切除术的选定患者（中位年龄63岁），通过使用游离空肠自体移植恢复了上消化道的连续性。23例（36%）此前未接受过治疗，术后接受放疗。8例患者放疗后出现喉肿瘤复发，28例（48%）患者术前接受过放疗。
随访时间为1至127个月（平均37个月）。最初有5例患者因血管问题发生移植组织坏死。4例患者的空肠成功被另一节段替代，1例患者进行了胃移位术。8例患者出现瘘管，其中4例需要手术治疗。死亡率为8.5%。出院后，6例患者因狭窄形成导致吞咽困难而再次手术。4例患者的远端或近端吻合口进行了修复，另外2例患者的移植组织分别被另一节段和结肠自体移植组织替代。术后1年，85%的患者报告吞咽功能良好，经口摄入正常。该选定患者组的总体5年生存率为42%，无原发性淋巴结受累患者的5年生存率为66%。所有原发性局部区域转移患者均在术后34个月内死亡。
喉咽切除术后采用游离空肠自体移植重建上消化道似乎是一种相对安全的手术，死亡率和发病率可接受，对于无局部淋巴结受累的患者，长期效果良好。
