하인두및 경부식도 재건술-인두위문합술, 유리공장이식술 및 전박유리피판술의 비교

Abstract

The reconstructive methods for hypopharynx and cervical esophagus after wide resection of extensive head and neck cancers include various myocutaneous flaps, usage of digestive tracts such as pharyngogastric anastomosis, free jejunal graft and radial foream free flap. Each method has advantages and disadvantages. Twenty three cases of reconstruction were reviewed which were performed using one of three kinds of reconstructive methods during the past 9-year period from March, 1986 and February, 1995. Of which, 7 cases were reconstructed by gastric pull-up, 9 cases by free jejunal graft and 7 cases were reconstructed using radial forearm free flap at Severance Hospital. All the flaps were used simultaneously with ablative oncologic surgery. The survival rates of the flap were 71.4% in gastric pull-up, 100% in jejunal free graft and forearm free flap. Pulmonary and intraabdominal complications occurred in gastric pull-up and free jejunal graft cases. Some fistulae were noted throughout the three reconstructive methods, which were successfully stabilized by conservative managements. Oral feeding was well tolerated in most of the living patients(100% in gastric pull-up and forearm free flap, 77.8% in free jejunal graft). We concluded that the gastric pull-up was an ideal method of reconstruction in an extensive tumor involving the esophagus requiring total esophagectomy, the free jejunal graft and the forearm free flap were useful in a situation when only the cervical esphagus was removed. Because no single operation is suitable in every situation, the reconstructive method should be selected considering the extent of disease and furthermore the physical status of the patient.