Advanced hypopharyngeal cancer, laryngeal cancer recurrence and neck defects after the choice of the entire complex organizations
【Abstract】 Objective To investigate the different tissue grafts for reconstruction ? advanced hypopharyngeal cancer,
laryngeal cancer recurrence after neck, hypopharynx esophagus defect indications and therapeutic effect. Methods 36 patients with recurrent laryngeal cancer, tumor resection with pectoralis major muscle flap repair tissue defects in 18
cases, deltopectoral flap repair in 4 cases, gastric esophageal repair in 2 cases, breast reconstruction flap over the lower neck and upper mediastinum tissue defects, and eliminate dead space and 12 cases of surgery. 16 patients with advanced hypopharyngeal and cervical esophageal carcinoma in 8 cases, in order to free jejunal restoration in 1, contralateral laryngeal mucosa flap pharyngeal defect in 8 cases, larynx and trachea on behalf of the esophagus in 8 cases, pectoralis major flap pharyngeal defect in 2 cases, 2
cases of esophageal replacement with stomach, free radial forearm flap to swallow in 1 case. The results of surgery with no deaths, no postoperative repair tissue necrosis, all flaps survived. Use of contralateral laryngeal mucosa flap prosthetists, only 1 patients had a history of preoperative radiotherapy in patients with postoperative pharyngeal leak occurred, pectoralis major flap prosthetists pharyngeal leak occurred in 1 case, postoperative pharyngeal esophageal gastric leak in 1 case. All patients were healed to resume a normal diet. Follow-up of 984 months, 14 patients had
obstruction of swallowing can be into the liquid diet. Conclusions Patients with hypopharyngeal defects after repair
methods have focused on. Tumor location and size of post-
operative tissue defect repair method is to choose the most important factor; second, should be combined with patient's age and body conditions, consider reducing the complications.
Key words Hypopharyngeal cancer Laryngeal neoplasms and Neck
laryngeal recurrent carcinoma
Abstract: Objective To explore how to repair the hypopharyngeal and cervical defects after carcinoma removal in patients with hypopharyneal carcinoma of the advanced stage and laryngeal recurrent carcinoma. Method 36 cases of
recurrent laryngeal carcinoma were treated. The defects of 18 cases were repaired with pectoralis major flaps, of 4 with deltopectoralis skin flaps, of 2 with stomach replaced esophagus and of 12 with the flap shift from thoraces to cover
the dead space. Also 16 cases of late hypopharyngeal and eight cases of cervical esophageal carcinoma were treated in this study. The defects of 1 case was repaired with jejunal interposition, of 8 with laryngeal mucosal flaps from the
uninjured side, of 8 with laryngotracheal interpositions, of 2 with pectoralis major flaps, of 2 with stomach replaced esophagus, and of 1 with a free antebrachial flap. Results No one died during thehappened after the operations. All flaps survived. In cases repaired with laryngeal mucosal flaps, only 1 with pre operational radiotherapy suffered from
pharyngeal fistula. 1 case was repaired with a pectoralis major flap and 1 with a stomach replaced esophagus suffered from a pharyngeal fistula. All patients could intake semi
fluid after healing. Followed up for 9 to 84 months, 14 patients had dysphagia but still could intake semi fluid.
Conclusions All kinds of ways to reconstruct the defect of hypopharynx are good in different aspects and have different
indications. Location of the tumor and size of the defects are the most important factors for choosing the reconstruction method. Also, complications should be decreased.
Key words: Hypopharyngeal neoplasms; Laryngeal neoplasms;
1 Data and methods
1.1 The clinical data from January 1995 to January 2007 between the undergoing surgery in my section of the recurrent laryngeal cancer and 60 patients with advanced hypopharyngeal cancer, 58 males and 2 females, 40 78 years old, with an
average 64-year-old. Patients with recurrent laryngeal cancer, 36 cases, 16 patients with advanced hypopharyngeal and cervical esophageal cancer in 8 cases.
1.2 Methods Based on history and the CT (or MRI), fiber bronchoscopy, esophageal barium meal examination and so
determine the extent of the lesion and the location, the exclusion of mediastinum and lung metastasis after radical surgery for tumor purposes, with cervical lymph node metastasis, neck dissection at the same time surgery.
Recurrent laryngeal cancer, reconstructive method: stoma ?
genotype 6 routine stoma recurrence of cancer resection, resection of the trachea down to the first 58 tracheal rings, chest flap patch over; recurrence of cancer, type ?, ?, 15
Regular radical neck dissection, removal of stoma recurrence of cancer, part of the upper mediastinal dissection, intraoperative tumor boundaries proved a top-down along the
tracheal rings after the removal of tumor resection handle the upper sternum and clavicle head and upper mediastinal lymph
node dissection peri trachea. Partial laryngectomy recurrence underwent extended total laryngectomy. Excision repair defect of pectoralis major muscle flap in 18 cases, were cut flap or muscle flap for the 4? Cm × 5? Cm 10? Cm × 12? Cm,
deltopectoral flap repair in 4 cases, gastric esophageal repair 2 cases, chest passes under the neck flap
reconstruction of defects with the upper mediastinum and the eradication of surgical dead space in 12 cases.
Advanced hypopharyngeal and cervical esophageal cancer
reconstructive method: OK tumor resection, tissue defects in order to free the entire re-one cases of Campylobacter,
jejunum flap length 15? Cm, with the contralateral laryngeal
mucosa flap part of the pharyngeal defect in 8 cases,
laryngotracheal on behalf of the esophagus in 8 cases, pectoralis major muscle flap for pharyngeal defect in 2 cases, 4 cases of esophageal replacement with stomach, free radial forearm flap to swallow in 1 case.
Surgery with no deaths, no postoperative repair tissue necrosis, all flaps survived. All patients had a normal diet can be healed. Follow-up of 984 months, a cumulative survival rate was 42.63%, 3-year cumulative survival rate of 11.66%. 14 cases of obstruction occurred swallowing may enter liquid
diet. A total of 16 cases of complications, using contralateral laryngeal mucosa flap prosthetists, only 1 patients had a history of preoperative radiotherapy in patients with postoperative pharyngeal leak occurred; pectoralis major muscle flap prosthetists pharyngeal leak occurred in 1 case, on behalf of the postoperative stomach pharyngeal leak in 1 case. The remaining 4 cases of wound infection, skin dehiscence in 1 case, stoma infection in 2 cases, 6 cases of pneumonia and so on.
Can use its own throat flap pharynx and trachea of the patient, the general preservation of laryngeal function in surgery may be OK, but the mind associated with systemic diseases such as liver and lungs, cachexia, or frail, a wider
range of patients with lesions in order to prevent surgery After aspiration and other complications, does not consider preservation of laryngeal function. However, a normal part of the larynx can be preserved, made of laryngotracheal flap for
restoration of defects in the upper pharynx and esophagus, although the loss of laryngeal function in patients, but reduced the use of pectoralis major muscle flap, stomach and so on to mention separated by the organization of the surgical trauma repair defects. Its disadvantages such as stents that may affect the laryngeal cartilage repair firm, whereas excessive removal of cartilage and other supports
organizations that may affect the local tissue blood supply, so that the higher the incidence of pharyngeal fistula .
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3.1 total laryngectomy and tracheal reconstructive surgery after the shift most suitable for Central, District, cancer, derived from the cervical esophagus, pharynx posterior
ring T1, T2 lesion tumor resection and restoration, are also suitable for the lower posterior wall of hypopharynx The T1 and T2 lesions. Tracheal rings in the first cross-section 2,3
trachea, lower trachea fistulization, endotracheal intubation. In order to suture pull the top of the trachea, through the trachea and esophagus partitions are up, and separated from the anterior wall of esophagus swallow throat singalong, flat on the edge of the cricoid cartilage or outer wall of the pyriform sinus into the pharynx, under direct vision from the tumors on the edge of 2 3? cm at circumcision swallow mucous membranes, flat 3 circumcision esophageal tracheal ring plane, separating both sides of the soft tissue and thyroid tumor Jibei complete resection. Carefully remove the thyroid
cartilage, the laryngeal mucosa catchy cutting edge of breaking edge of hypopharyngeal mucosa sutured trachea and esophagus broken off edge suture. The advantage is less damage, quick recovery drawback is that patients will lose their laryngeal function.
3.2 hypopharyngeal half-swallow, semi-post-laryngectomy
laryngeal flap plasty would be unaffected side of the thyroid cartilage and cricoid cartilage membrane under the former Ministry of resection, resection of contralateral half of
hyoid bone, laryngeal mucosa to increase flexibility, make it easier to Flip in place reconstruction of pharynx. Intraoperative care to preserve the blood supply in order to avoid the formation of postoperative pharyngeal fistula.
3.3 neck skin defect with large deltopectoral flap is more convenient to the entire complex, tumor resection, according to the size and shape of the neck defect in the chest from the shoulder inward, to close the sternum handle Office for width 8 10? Cm a length of about 16 20? cm of
transverse skin flap, including the subcutaneous tissue and
the internal thoracic artery in 23 intercostal perforator. Reveal from outside to inside flap, we should pay attention not to damage the blood vessels. The flap to the neck to
reverse the defect, its remote and both sides of the cutting edge with the corresponding cutting edge on the bit interrupted skin suture, shoulder traction suture defect, or purchase on behalf of Dole's skin [2 3].
Pharynx large defect of pectoralis major muscle flap can
be a whole line of stage ?, complex repair of pectoralis
major surface of the skin from the chest acromial artery and its blood supply pectoral branch of the artery from the subclavian artery and its first since the collarbone Traveling
the midpoint of the vertical down 2 4? cm after the connection through the acromion and the Xiphoid oblique downward, experts in the pectoralis major and chest deep fascia between the inherent. On the ipsilateral chest in the acromion to draw the connection with the Xiphoid hypopharyngeal defects with equivalent or slightly larger than the skin island contours to cutting-edge and end of each is equal to or slightly longer than the upper edge of hypopharyngeal defect to the ipsilateral clavicle in the point distance. The skin island
through the subcutaneous tunnel defect to move to swallow, and swallow the corresponding cut edge of mucosa sutured to the position. Pectoralis major muscle flap blood supply is good, thick pedicle can fill the pharyngeal defect, but not suitable
for posterior wall and ring defects, due to thicker pectoralis
major muscle flap to form a skin tube to swallow the entire complex, neck Esophageal rings cut from time to time after the defect caused by a narrow pharynx, swallowing block, it is difficult to swallow; posterior wall with split thickness skin
graft in a joint restoration.
3.4 The removal of gastric esophageal circular plasty put off the left gastric, short gastric and left gastric retinal blood vessels, right gastric and right gastric retention retinal blood vessels, free gastric body, neck and abdomen
after blunt thoracic esophagus separated by the tongue cut into the pharyngeal bones, cut off from the base of the tongue flat hypopharynx, its on the cutting edge must be 3? cm safety of the edge of the esophagus and the stomach pulled up to his
neck after the sutures. As the stomach in the chest after the
last mention should be made pyloric shape in order to prevent reflux of food. Great for hypopharyngeal and cervical esophageal defects effective, easy to necrotic, better than
The application of free flaps with partial functional recovery is good, less complications and low donor site morbidity, and the application of no age restrictions. On the head and neck defects after cancer surgery can not only repair
of two-dimensional, but also the repair and function of three-
dimensional reconstruction. For the hypopharyngeal and cervical esophageal defect after resection of large, free jejunal and radial forearm flap is frequently used in the repair material, but require a high level of vascular anastomosis, and patients require close observation of flap survival conditions [4 5].
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