管状胃上提术在下咽颈段食管癌术中应用(附5例报告)

Gastric pull-up reconstruction after hypopharyngo-esophagectomy for carcinoma of hypopharynx and cervical esophagus(with a report of 5 cases)

摘要:

目的 探讨管状胃上提术在下咽颈段食管癌术中的应用,并分析其临床特征。方法 回顾分析管状胃上提术在下咽颈段食管癌术应用5例患者的临床资料。结果 5例下咽颈段食管癌初发者4例,复发者1例；胸腔镜辅助下管状胃上提术4例,达芬奇机器人辅助下管状胃上提术1例；保留喉功能全咽全食管切除2例,喉全切+全咽+全食管切除3例；术后病理为鳞癌4例、腺癌1例；术后一过性胸腔瘘1例,术后放疗后咽瘘1例；术后1月内全部恢复经口饮食。随访6个月~44个月,死亡3例(术后6月因肺转移癌肺出血死亡1例,术后13月因局部复发并发心衰死亡1例,术后44个月因食管、肺转移并发恶液质死亡1例)；带瘤生存2例(术后1年肺转移1例,术后3月颈淋巴结转移、术后11月腹腔淋巴结及肾上腺转移1例)。结论 下咽颈段食管癌恶性程度高,腺癌少见,胸腔镜或达芬奇机器人辅助下咽颈段食管癌术中管状胃修复术在围手术期并发症可控,值得推荐应用。

Abstract:

ABSTRACT Objective To inverstigate the application of thoracoscopic gastric pull-up reconstruction after hypopharyngo-esophagectomy and analyze the clinical characteristics of carcinoma of hypopharynx and cervical esophagus. Methods The clinical data of 5 patients with carcinoma of hypopharynx and cervical esophagus reconstructed with gastric pull-up were retrospectively analyzed. Results Of the 5 cases of carcinoma of hypopharynx and cervical esophagus, 4 cases had initial onset and 1 case had recurrence. Thoracoscopy was assisted in 4 cases and Da Vinci robot was assisted in one cases. Hypopharyngo-esophagectomy with reserved laryngeal function were carried out in 2 cases, and hypopharyngo-laryngo-esophagectomy were carried out in 3 cases; 4 cases of squamous cell carcinoma and 1 case of adenocarcinoma were confirmed in histopathology. Postoperative transient thoracic fistula in 1 case, pharyngeal fistula after radiotherapy in 1 case; All patients resumed oral intake within 1 month after surgery. The following-up from 6 months to 44 months postoperative, 3 cases died (one case died due to pulmonary hemorrhage 6 months postoperative, one case died due to local recurrence with heart failure 13 months postoperative, and one cases died due to esophageal and lung metastasis 44 months postoperative). 2 patients survived with tumor (lung metastasis 1 year postoperative, cervical lymph node metastasis 3 months postoperative, abdominal lymph node and adrenal metastasis 11 month postoperative). Conclusion The malignant degree of hypopharyngeal and cervical esophageal cancer is high, and adenocarcinoma is rare. The perioperative complications may be controlled in gastric pull-up assisted with thoracoscopic or Davinci robot after hypopharyngo-esophagectomy, which is worthy of recommendation.