Abstract：
BACKGROUND: Total pharyngolaryngectomy is sometimes combined with total glossectomy for advanced hypopharyngeal or cervical esophageal cancers involving the tongue base. The optimal reconstruction method for total pharyngolaryngectomy with total glossectomy has not been established due to a considerable diameter mismatch between the floor of mouth and the esophageal stump. This report describes two reconstruction methods using free jejunal transfer.
METHODS: Five consecutive patients who underwent total pharyngolaryngectomy with total glossectomy were included, with a mean age of 67.0 (range 55-75) years. Primary tumors included tongue, hypopharyngeal, cervical esophagus, and laryngeal cancers. The mean defect size was 17.0 (16-19) × 6.8 (6-7) cm. Surgical techniques involved either a simple incision or a two-segment method to address the size mismatch between the jejunum and the floor of mouth. In the simple incision method, a longitudinal cut was made to the antimesenteric or paramesenteric border of a jejunum wall to expand the orifice. In the two-segment method, a jejunal graft was separated into two segments to reconstruct the floor of mouth and the cervical esophagus, and these segments were connected with a longitudinal incision to the cervical esophageal segment to form a funnel-shaped conduit.
RESULTS: Of the five patients, three underwent the simple incision method and two the two-segment method. Postoperative pharyngoesophagography showed a smooth passage for all patients. Postoperative courses were uneventful except for one flap loss due to arterial thrombosis. Four patients achieved oral feeding, while one became gastric-tube dependent. At a mean follow-up of 22.1 (4-39) months, one patient required tube feeding, two tolerated full liquid, and two consumed a soft diet.
CONCLUSIONS: Both the simple incision and two-segment methods achieved satisfactory swallowing function. The choice between these reconstruction methods may depend on the extent of resection of the posterior pharyngeal wall.
METHODS: Five consecutive patients who underwent total pharyngolaryngectomy with total glossectomy were included, with a mean age of 67.0 (range 55-75) years. Primary tumors included tongue, hypopharyngeal, cervical esophagus, and laryngeal cancers. The mean defect size was 17.0 (16-19) × 6.8 (6-7) cm. Surgical techniques involved either a simple incision or a two-segment method to address the size mismatch between the jejunum and the floor of mouth. In the simple incision method, a longitudinal cut was made to the antimesenteric or paramesenteric border of a jejunum wall to expand the orifice. In the two-segment method, a jejunal graft was separated into two segments to reconstruct the floor of mouth and the cervical esophagus, and these segments were connected with a longitudinal incision to the cervical esophageal segment to form a funnel-shaped conduit.
RESULTS: Of the five patients, three underwent the simple incision method and two the two-segment method. Postoperative pharyngoesophagography showed a smooth passage for all patients. Postoperative courses were uneventful except for one flap loss due to arterial thrombosis. Four patients achieved oral feeding, while one became gastric-tube dependent. At a mean follow-up of 22.1 (4-39) months, one patient required tube feeding, two tolerated full liquid, and two consumed a soft diet.
CONCLUSIONS: Both the simple incision and two-segment methods achieved satisfactory swallowing function. The choice between these reconstruction methods may depend on the extent of resection of the posterior pharyngeal wall.
摘要：
背景：对于涉及舌根的晚期下咽或颈段食管癌，有时将咽喉全喉切除术与舌根全舌切除术联合使用。由于口底和食道残端之间的直径不匹配，尚未建立全咽喉切除术和全舌切除术的最佳重建方法。本报告描述了两种使用自由空肠转移的重建方法。
方法：纳入5例连续行全咽喉切除术和全舌骨切除术的患者，平均年龄为67.0岁（范围55-75岁）。原发性肿瘤包括舌头，下咽,颈食管,和喉癌.平均缺损尺寸为17.0（16-19）×6.8（6-7）cm。手术技术涉及简单的切口或两段方法，以解决空肠和口底之间的大小不匹配。在简单的切口法中，对空肠壁的肠系膜或肠系膜旁边界进行纵向切割以扩大孔口。在两段法中，将空肠移植物分成两段以重建口底和颈食管，这些段与颈食管段的纵向切口相连，形成漏斗状导管。
结果：在5名患者中，三种采用简单切口法，两种采用两段法。术后咽食管造影显示所有患者通道顺畅。术后过程顺利，除了由于动脉血栓形成而导致的一个皮瓣丢失。四名患者实现了口服喂养，而一个人变得依赖胃管。平均随访22.1(4-39)个月，一名患者需要管饲，两种耐受的全液体，和两个消耗软饮食。
结论：简单切口和两段方法均可获得满意的吞咽功能。这些重建方法之间的选择可能取决于咽后壁的切除程度。
方法：纳入5例连续行全咽喉切除术和全舌骨切除术的患者，平均年龄为67.0岁（范围55-75岁）。原发性肿瘤包括舌头，下咽,颈食管,和喉癌.平均缺损尺寸为17.0（16-19）×6.8（6-7）cm。手术技术涉及简单的切口或两段方法，以解决空肠和口底之间的大小不匹配。在简单的切口法中，对空肠壁的肠系膜或肠系膜旁边界进行纵向切割以扩大孔口。在两段法中，将空肠移植物分成两段以重建口底和颈食管，这些段与颈食管段的纵向切口相连，形成漏斗状导管。
结果：在5名患者中，三种采用简单切口法，两种采用两段法。术后咽食管造影显示所有患者通道顺畅。术后过程顺利，除了由于动脉血栓形成而导致的一个皮瓣丢失。四名患者实现了口服喂养，而一个人变得依赖胃管。平均随访22.1(4-39)个月，一名患者需要管饲，两种耐受的全液体，和两个消耗软饮食。
结论：简单切口和两段方法均可获得满意的吞咽功能。这些重建方法之间的选择可能取决于咽后壁的切除程度。
