【摘要】 目的 觀察全喉全下咽切除術(shù)后空腸游離移植術(shù)二次手術(shù)時同時保留動靜脈血管蒂或僅保留動脈血管蒂時對移植組織的影響。 方法 回顧分析2002年1月-2009年12月4例下咽癌行全喉全下咽切除術(shù)空腸游離移植術(shù)術(shù)后8~18個月因頸部轉(zhuǎn)移灶出現(xiàn)而需再行手術(shù)患者的臨床資料，其中3例行根治性頸清掃，1例行局部包塊擴(kuò)大切除術(shù)。2例同時保留動靜脈蒂，2例僅保留動脈蒂。 結(jié)果 4例術(shù)后臨床Ⅰ期愈合。保留動靜脈蒂者吞咽功能與術(shù)前無異。僅保留動脈蒂者術(shù)后1個月仍有頸中份的明顯隱痛，胃腸造影移植空腸段的蠕動明顯減弱，吞咽固體食物時自覺較術(shù)前緩慢。 結(jié)論 再次手術(shù)時保留血管蒂對于保持空腸移植段的活力具有重要的意義。
【Abstract】 Objective To observe the effect of keeping arteriovenous or venous pedicles during the second free jejunal transplantation after total laryngopharyngectomy on the transplanted tissues. Methods From January 2002 to December 2009,four patients underwent total laryngopharyngectomy and free jejunal. But 8-18 months later, the patients underwent another operation because of recurrent metastatic mass in the ipsilateral neck side of anastomosis; in whom three underwent radical neck dissection and one underwent local enlarged mass resection. In the four patients, two had arteriovenous pedicles remained and another two kept only venous pedicles. Results All of the four patients experienced first-stage healing. The deglutitive function in the two patients who had received the arteriovenous pedicles preservation didn’t differ much from that before the operation. While vague anguish in the anterior region of the neck, weak peristalsis of the transplanted jejunum, a little discomfort and slow swallowing were found in another two patients. Conclusion Keeping vascular pedicles during re-operation helps make the activity of the transplanted jejunum.
引用本文： 張先強(qiáng),李文,王奕娟,李慧,吳春樹. 游離空腸移植術(shù)后再手術(shù)時對血管蒂的保護(hù). 華西醫(yī)學(xué), 2011, 26(3): 372-374. doi: 復(fù)制
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- 1. Moradi P, Glass GE, Atherton DD, et al. Reconstruction of pharyngolaryngectomy defects using the jejunal free flap: a 10-year experience from a single reconstructive center[J]. Plast Reconstr Surg, 2010, 126(6): 1960-1966.
- 2. Ott K, Lordick F, Molls M, et al. Limited resection and free jejunal graft interposition for squamous cell carcinoma of the cervical oesophagus[J]. Br J Surg, 2009, 96(3): 258-266.
- 3. Chen HC, Rampazzo A, Gharb BB, et al. Motility differences in free colon and free jejunum flaps for reconstruction of the cervical esophagus[J]. Plast Reconstr Surg, 2008, 122(5): 1410-1416.
- 4. Numajiri T, Fujiwara T, Nishino K, et al. Artery-dominant free jejunal transfer[J]. J Plast Reconstr Aesthet Surg, 2010, 63(3): 446-450.
- 5. 李樹玲. 新編頭頸腫瘤學(xué)[M]. 2版. 北京: 科學(xué)技術(shù)文獻(xiàn)出版社, 2002: 824.
- 6. Wang HW, Chu PY, Kuo KT, et al. A reappraisal of surgical management for squamous cell carcinoma in the pharyngoesophageal junction[J]. J Surg. Oncol, 2006, 93(6): 468-476.
- 7. Yu P, Lewin JS, Reece GP, et al. Comparison of clinical and functional outcomes and hospital costs following pharyngoesophageal reconstruction with the anterolateral thigh free flap versus the jejunal flap[J]. Plast Reconstr Surg, 2006, 117(3): 968-974.
- 8. Biel MA, Maisel RH. Free jejunal autograft reconstruction of the pharyngoesophagus: review of a 10-year experience[J]. Otolaryngol Head Neck Surg, 1987, 97(4): 369-375.
- 9. Nomura T, Hachiya O, Suzuki A, et al. Reconstruction methods after total pharyngolaryngoesophagectomy: free jejunal graft and venous-reconstructed gastric tube or gastric tube alone[J]. Hepatogastroenterol, 2008, 55(86-87): 1622-1626.
- 10. Sarukawa S, Asato H, Okazaki M, et al. Clinical evaluation and morbidity of 201 free jejunal transfers for oesophagopharyngeal reconstruction during the 20 years 1984-2003[J]. Scand J Plast Reconstr Surg Hand Surg, 2006, 40(3): 148-152.
- 11. 張滌生. 顯微整復(fù)外科學(xué)[M]. 北京: 人民衛(wèi)生出版社, 1985: 120-132.
- 12. Disa JJ, Pusic AL, Hidalgo DA, et al. Microvascular reconstruction of the hypopharynx: defect classification, treatment algorithm, and functional outcome based on 165 consecutive cases[J]. Plast Reconstr Surg. 2003, 111(2): 652-660.