Application Of Residual Laryngeal Mucosa Flap In Surgical Repair Of Hypopharyngeal Carcinoma

Objective:To explore the application of residual laryngeal mucosa flap in surgical repair of hypopharyngeal carcinoma.Methods:48 patients hypopharyngeal carcinoma were treated by surgery.The TNM stages of 48 patients were T₂N₀M₀8 cases,T₂N₁M₀7 cases,T₂N₂M₀7 cases,T₃N₀M₀10cases,T₃N₁M₀9 cases,T₃N₂M₀6 cases and T₄N₂M₀1 cases.According to the primary location of the tumor,the surgical approaches were selected:epiglottis valley,lateral wall or tip of pyriform fossa entering the pharyngeal cavity.According to the stage and grade evaluation,For patients with N+type,selective neck dissection or modified radical neck dissection should be performed on one side or both sides;For patients without cervical lymph node metastasis（c N0）,neck lymph node dissection should be performed at least in areasⅡ～Ⅳ,including areasⅠ、Ⅴ、Ⅵwhen necessary.Evaluate the changes of patients’condition and physical condition,and receive radiotherapy or chemotherapy one month after operation.Results:All 48 patients recovered normal swallowing function in a short time.Local infection and pharyngeal fistula were found in 3 patients 6 days after operation.The pharyngeal fistula was less than 2 cm,accounting for 6.25%（3/48）,and healed within 2weeks after local dressing change.Anastomotic stenosis occurred in 2 patients（6.25%,2/32）after operation,and improved after corresponding expansion.Among them,16patients underwent total laryngectomy and breathed smoothly after operation.Tracheal cannula was removed in 30 patients within 3 months after operation,and extubation rate was 94%（30/32）in 2 patients 6 months after operation.The laryngeal cavity of 2 patients was narrow after operation,which made it impossible to extubate.Local recurrence+cervical metastasis+distant metastasis（lung metastasis）occurred in 2 cases within 3 years.Local recurrence+esophageal metastasis occurred in 1 case within 3 years.One patient was depressed（self-catheter removal）,and 5 patients lost follow-up.The 3 year survival rate was 81.3%（39/48）.Conclusion:Repairing hypopharyngeal defect after partial hypopharyngeal cancer resection with residual laryngeal mucosa flap has the advantages of taking materials nearby,not increasing incision,less trauma,strong anti-infection ability,easy survival and relatively few complications.