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目的 :探讨喉癌下咽癌患者下咽或下咽及颈段食管术后缺损的修复方法。方法 :对保留喉功能的下咽术后缺损 9例 (伴颈段食管部分切除 3例 ,颈段食管癌行食管全切除 1例 ) ,用胸大肌肌皮瓣修复 4例 ,直接修复 4例 ,胃咽吻合术 1例。不保留喉功能 2 0例 (伴颈段食管部分切除 2例 ) ,舌瓣修复 16例 ,喉组织瓣 2例 ,胸大肌肌皮瓣与胸骨舌骨肌筋膜瓣联合重建下咽 2例。结果 :术后 8例Ⅰ期恢复吞咽及喉功能 ,1例下咽狭窄 ,Ⅱ期行残喉切除。余 2 0例中 16例Ⅰ期恢复吞咽功能 ,1例下咽狭窄经扩张进食 ,3例咽瘘 ,其中 1例咽瘘行Ⅱ期胃咽吻合术。 1、3及 5年的生存率分别为 92 %、6 4 .7%和 4 6 .2 %。结论 :保留喉功能的下咽或下咽及颈段食管缺损可直接修复或采用胸大肌皮瓣修复 ,不保留喉功能者 ,可采用舌瓣、胸大肌皮瓣修复或咽胃吻合术。肌皮瓣和肌筋膜瓣联合重建全下咽易引起下咽狭窄或咽瘘
Objective: To investigate the repair of hypopharyngeal or hypopharyngeal and cervical esophageal defect after laryngeal cancer patients with hypopharyngeal carcinoma. Methods: Nine cases of hypopharyngeal defects with laryngeal function preserved (3 cases with esophagectomy with cervical segment and 1 case with esophageal resection of cervical esophagus), 4 cases were repaired with pectoralis major myocutaneous flap, and 4 cases were directly repaired Cases, stomach anastomosis in 1 case. The laryngeal function was not preserved in 20 cases (partial esophageal resection in 2 cases), flap repair in 16 cases, laryngeal flap in 2 cases, pectoralis major myocutaneous flap and sternohyoid myoflagella flap reconstruction in 2 cases . Results: In the first postoperative period, swallowing and laryngopharyngeal function were recovered in the first stage, swallowing stenosis in one case and resection in the second stage. Among the remaining 20 cases, 16 cases recovered swallowing function in stage Ⅰ, 1 case swallowed by stenosis, 3 cases pharyngeal fistula, and 1 case pharyngeal fistula performed stage Ⅱ anastomosis. The 1, 3 and 5 year survival rates were 92%, 64.7% and 46.2%, respectively. CONCLUSIONS: Laryngeal or hypopharyngeal esophageal defects with preserved laryngeal function can be directly repaired or repaired with the pectoralis major myocutaneous flap without preserving the laryngeal function. The flap, pectoralis major myocutaneous flap or pharyngeal anastomosis can be used . Reconstruction of myocutaneous flap and myofascial flap pharyngeal sore throat or pharyngeal fistula