유리피판을 이용한 하인두-식도 재건 치험례

Abstract

Hypopharyngo-esophageal cancer is usually found at late stage. Its main treatment is surgical intervention and it often requires radical resection. Reconstruction of the hypopharyngo-esophageal defect after the resection of carcinomas of the hypopharynx and the cervical esophagus has traditionally been carried out with deltopectoral or musculocutaneous flap. Another approach is to reconstruct the defect with the colon or stomach. Recent advances in microvascular surgical techniques have resulted in one stage reconstruction with free flap. Both jejunal free flap and radial forearm free flap is a good alternative for the reconstruction of hypopharyngo-esophageal defect. Six cases of the radial forearm flap and nine cases of the jejunal flap were used to reconstructed the hypopharyngo-esophageal defect in 15 patients. In jejunal free flap, upper margin was reconstructed with end to side anastomosis and lower margin with end to end anastomosis. In radial forearm free flap, we used trapezoid shaped flap and tubed by complete or partial tubing according to the condition of the defects. Stricture and fistula are troublesome complications. The complications were peritonitis(n=1) and fistula(n=1). We concluded that both forearm and jejunal free flap is a useful alternative in reconstruction of hypopharynx and cervical esophagus.