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Objective@#To evaluate the efficacy of gastric pull-up and complex laryngotracheal flap in reconstruction for circumferencial defects after resection of hypopharyngeal and cervical esophageal cancers.@*Methods@#A total of 163 cases (152 males, 11 females) with circumferencial defect after resection of hypopharyngeal and cervical esophageal cancers received reconstructive surgeries by gastric pull-up (42 cases) and complex laryngo-tracheal flaps (121 cases), of them 115 cases simultaneously underwent unilateral neck dissection and 20 cases had bilateral neck dissection. Postoperative radiotherapy was used in 67 cases, with a dosage of 40-60 Gy.@*Results@#There were 127 (77.9%) cases with positive metastatic lymph nodes. Of 42 patients with gastric pull-up reconstruction, 39 cases (92.8%) recovered the function of oral swallowing after operation, and 8 cases with cervical esophageal cancer recovered the functions of oral swallowing and speech after gastroesophageal anastomosis reconstruction. There were 3 (7.1%) cases died of surgery and 8 cases with surgical complications. Reconstruction of upper digestive tract with combined laryngotracheal flap was successful in all 121 cases, with recovered oral swallowing function after operation. No patient died of surgery but 24 cases had complications, mainly pharynx skin fistula or wound infection, which were cured by conservative treatments. The 1-, 3- and 5-year survival rates for 163 patients were 69.8%, 50.5% and 34.3%, respectively. The independent factors for prognosis included T4 (P<0.001) and N+ (P=0.042).@*Conclusions@#The complex of laryngotracheal flap with pectoralis major myocutaneous flap is suitable for most advanced hypopharyngeal cancer after resection of the tumor and reconstruction of circumferencial defect. It is simple technology, low and slight complication rate. The minority is not suitable for the application of pectoralis major myocutaneous flap can be used instead of free anterolateral thigh flap. Gastric pull-up for reconstruction of upper digestive tract is suitable for most patients with cervical esophageal cancer and hypopharyngeal carcinoma invading the cervical esophagus who are not suitable for laryngotracheal flap reconstruction, with good swallowing function after surgery. However, it is prudent to choose operative indications because of serious surgical trauma and risks for complications.
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OBJECTIVE@#To summary the clinical therapy experience of thyroid carcinoma invading cervical esophagus and trachea full thickness and reconstruction of them to improve the survival rate and quality of life of these patients.@*METHOD@#In 33 patients with thyroid carcinoma inviding cervical esophagus and trachea, 7 patients were operated with total thyroid resection, 22 patients were operated with one lobectomy and the other side subtotal thyroid resection,and 4 patients were operated with partial lobectomy. Trachea local recection and intubation were performed on 19 patients, partial laryngectomy and pyriform sinus resection with trachea local recection and intubation were performed on 4 patients,and 10 cases were operated with tracheal sleeve resection and end to end anastomos.@*RESULT@#All patients were primary healing without tracheal anastomosis fistula, tracheal wall necrosis, esophageal fistula and pharyngeal fistula. One case had hypoparathyroidism after the operation and took a favorable turn a month later. Seven cases were dead (21. 21%). 1-year, 3-year, 5-year survival rates of the thyroid papillary carcinoma inviding cervical esophagus and trachea were 100.0%, 93.8% and 70.3%; 1-year, 3-year, 5-year survival rates of the thyroid carcinoma inviding cervical esophagus and trachea were 96.6%, 79.0% and 61.4%.@*CONCLUSION@#Thyroid carcinoma invading cervical esophagus and trachea full-thickness can be treated with surgical methods, and tracheal sleeve resection and end to end anastomos are the suitable methods.
Subject(s)
Humans , Carcinoma , Pathology , General Surgery , Carcinoma, Papillary , Esophagus , Pathology , Laryngectomy , Neoplasm Invasiveness , Quality of Life , Plastic Surgery Procedures , Survival Rate , Thyroid Cancer, Papillary , Thyroid Neoplasms , Pathology , General Surgery , Trachea , Tracheal Neoplasms , Pathology , General SurgeryABSTRACT
Objective To summarize the clinical experience of reconstruction by using free flap after operation of head and neck tumor. Method A retrospective review was performed of 36 cases who were operated with free flap to reconstruct postoperative defects in head and neck tumor from March 2007 to March 2009, 28 cases repaired by free anterolateral thigh(ALT) flap, 8 cases repaired by free forearm flap. Results The operations of 26 cases repaired with free ALT flap were successful, 2 cases were necrosis. Vascular pedicle flap was 8-18 cm long, mean 12.5 cm, 25 cases were muscle skin perforator, 3 cases were muscle clearance wear. Eight cases of free forearm flap were successful. All of 36 cases recovered well. Conclusions The successful rate of free flap is perfect, and there is no serious complication in doner-site. The flap can be shaped into various forms. Free flap is an ideal measure to reconstruct hypopharynx and to preserve the laryngeal function.
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0.05).Tongue base resection(P=0.0164)and different methods of reconstruction(P=0.0011)had significant effects on the swallowing function.CONCLUSION The main factors of influencing swallowing function after resection of oral and oropharyngeal cancers are presence or absence of tongue base resection and different methods of reconstruction.