Nakatsuka T, Harii K, Asato H, Ebihara S, Yoshizumi T, Saikawa M
Department of Plastic and Reconstructive Surgery, Faculty of Medicine, University of Tokyo, Japan.
Scand J Plast Reconstr Surg Hand Surg. 1998 Sep;32(3):307-10. doi: 10.1080/02844319850158651.
We reviewed 109 consecutive patients with cancer of the hypopharynx or cervical oesophagus who underwent free flap transfer for immediate reconstruction after total pharyngolaryngo-oesophagectomy. The free flaps used were either free jejunal (n = 70) or radial forearm flaps (n = 39). Significantly more fistulas (3/70 compared with 15/39, p < 0.0001) and strictures (6/64 compared with 13/33, p = 0.0008) developed in the radial forearm than the jejunal flap group. However, functional donor site morbidity was minimal and there were no cases of total flap necrosis in the forearm flap group. We consider that the free jejunal flap should be the first choice for total reconstruction of pharyngo-oesophageal defects. However, the forearm flap is suitable for elderly, high risk patients, because it is less invasive and has minimal donor site morbidity, which facilitates early recovery.
我们回顾了109例连续性下咽或颈段食管癌患者，这些患者在全喉咽食管切除术后接受了游离皮瓣移植进行即刻重建。所用的游离皮瓣为游离空肠瓣（n = 70）或桡侧前臂皮瓣（n = 39）。桡侧前臂皮瓣组发生瘘（3/70对比15/39，p < 0.0001）和狭窄（6/64对比13/33，p = 0.0008）的情况明显多于空肠瓣组。然而，供区功能损伤极小，前臂皮瓣组没有出现皮瓣完全坏死的病例。我们认为游离空肠瓣应是咽食管缺损全重建的首选。然而，前臂皮瓣适用于老年、高危患者，因为其侵袭性较小且供区损伤极小，有利于早期恢复。
