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目的探讨游离空肠修复下咽及颈段食管肿瘤切除术后组织缺损的方法和疗效。方法对1984年9月至2004年8月收治的51例下咽、颈段食管癌及喉癌复发患者以游离空肠修复肿瘤切除术后下咽及颈段食管组织缺损的临床资料进行回顾性分析。结果51例患者中,5例游离空肠修复术后出现游离空肠坏死,46例(90%)成功修复组织缺损。修复术后1年生存率为62%,3年生存率为48%。影响预后的因素有:(1)肿瘤切除切口边缘(切缘)情况:阴性切缘患者1年生存率为75%,3年生存率为58%;阳性切缘患者的1年生存率为34%,3年生存率为0。两者比较,差异均有统计学意义(P<0·01)。(2)肿瘤外侵情况:无甲状腺、皮肤、椎前组织、颈总动脉受侵(包括喉、气管、口咽受侵)34例,1年生存率为70%,3年生存率为42%;有甲状腺和(或)皮肤和(或)椎前组织和(或)颈总动脉受侵17例,1年生存率为44%,3年生存率为29%,两者比较,差异均有统计学意义(P<0·05)。放疗与否、肿瘤细胞分化类型对预后的影响,差异无统计学意义。5例术后出现游离空肠坏死的患者中,1例感染死亡,其余无严重并发症。结论以游离空肠修复下咽及颈段食管部位肿瘤切除术所致缺损,并发症较少,切缘阴性及无甲状腺、皮肤、椎前组织、颈总动脉受侵患者的1年、3年生存率较高;改善了患者的进食状况;对能保证切缘阴性、肿瘤切除局部及颈部淋巴结无明显外侵的患者,可应用游离空肠修复。
Objective To explore the method and effect of free jejunum in repairing tissue defects after resection of hypopharyngeal and cervical esophageal tumors. Methods The clinical data of 51 patients with hypopharynx, cervical esophageal cancer and recurrent laryngeal cancer who were treated from September 1984 to August 2004 were retrospectively analyzed with free jejunostomy to repair the defects of hypopharynx and cervical esophagus after tumor resection. . Results Of the 51 patients, 5 cases had free jejunal necrosis after free jejunal repair. 46 cases (90%) successfully repaired tissue defects. The 1-year survival rate after repair was 62%, and the 3-year survival rate was 48%. The factors affecting the prognosis are: (1) The edge of the resection margin (resection margin): The 1-year survival rate of the negative margin is 75%, the 3-year survival rate is 58%, and the 1-year survival rate of the positive margin is 34%. %, the 3-year survival rate is 0. Comparing the two, the difference was statistically significant (P<0.01). (2) Tumor invasion: No thyroid, skin, prevertebral tissue, common carotid artery invasion (including laryngeal, tracheal, and oropharyngeal invasion) 34 cases, 1 year survival rate was 70%, 3 year survival rate was 42 %; There were 17 cases of thyroid and/or skin and/or prevertebral tissue and/or common carotid artery invasion. The 1-year survival rate was 44%, and the 3-year survival rate was 29%. Statistically significant (P<0.05). There was no significant difference in the effect of radiotherapy or tumor differentiation type on the prognosis. Of the 5 patients who developed free jejunal necrosis, 1 died of infection and the rest had no serious complications. Conclusion Free jejunum can repair the defects caused by tumor resection of the hypopharynx and cervical esophagus. The complications are few, and the one-year and three-year survival of patients with negative margins and no thyroid, skin, prevertebral tissue, and common carotid artery invasion. The rate is higher; the patient’s eating condition is improved; free jejunal repair can be applied to patients who can ensure that the margin is negative, the tumor is removed locally, and there is no obvious external invasion of the cervical lymph nodes.