Total Laryngectomy And Esophageal Resection, Gastric-pharyngeal Anastomosis For Treatment Of Cervical Esophageal And Hypopharyngeal Carcinoma

objective:In this paper, the five cases of hypopharyngeal and cervical esophageal cancer were treated with total laryngectomy and esophageal resection and then Gastric-pharyngeal anastomosis,combined radiotherapy and chemotherapy after opration.to evaluate treatment effect and the treatment is feasible.method:5 cases in this group were male, of which 3 cases of cervical esophageal and hypopharyngeal carcinoma in 2 cases, age 51-64 years, mean 58.1 years old,Admission, in varying degrees of swallowing difficulties, No preoperative surgical contraindications such as systemic organ dysfunction and the important signs of distant metastasis.Postoperative pathology report were squamous cell carcinoma. Surgical treatment of the treatment process:The whole group are taking intravenous inhalation anesthesia, single-cavity endotracheal intubation, to be broken away from throat surgery to the trachea into the stage when re-intubation, anesthesia was maintained.Neck operation completed by the ENT physician, Take U-shaped incision or a T-shaped incision from the top of the cricoid cartilage away from the broken larynx, trachea, removal of the whole larynx, cricoid cartilage repair after any reservations to swallow most of the gastric mucosa in order to facilitate line pharynx anastomosis, parallel bilateral radical neck dissection, Another group obtained free of abdominal incision the stomach, the stomach free to sufficient length, Appropriate line jejunostomy.The group has two regular jejunostomy.Were taken to pull off the non-thoracic esophagus surgery. So that the stomach through the esophageal bed up to the neck, throat appetite at the end of the last line of double-row anastomosis reconstruction, trimmed with the distal tracheal cartilage ring placed into subcutaneous anterior cervical fistula.Results:All 5 patients resection rate was 100%,all patients underwent wide resection of esophageal resection plus whole hypopharynx, and a permanent tracheostomy fistula, all patients were stage I gastric-pharyngeal-side anastomosis.Postoperative complications occurred in this group Cervical anastomotic fistula in 1 case,the incidence of 20%, for fasting, total parenteral and enteral nutrition support. Fistula after partial medication directly through the second operation cured fistula repair.Surgery in this group 5 cases due to removal of the entire larynx, it is difficult to judge by the recurrent laryngeal nerve injury hoarseness;In addition to patients with anastomotic leakage occurred, the remaining patients were in the 7-10 d after oral feeding.Discharged patients can eat semi-liquid food.There are four cases of patients with varying degrees of gastric reflux, the incidence of 80%, I on the gastrointestinal motility drugs and sulfuric acid drug to ease slightly after.Postoperative radiotherapy and chemotherapy, follow-up to October 2009, all 5 patients are currently alive without local recurrence and distant metastasis.Conclusion:1.Total laryngectomy and total esophagectomy appetite at the end of anastomosis surgical treatment of cervical esophageal and hypopharyngeal carcinoma, high success rate, to achieve radical resection;2.Cervical esophageal carcinoma and hypopharyngeal carcinoma post-operative complications by strengthening the perioperative management and surgical techniques to improve the incidence of low and can be prevented;3.Cervical esophageal carcinoma and hypopharyngeal carcinoma with surgery-based comprehensive treatment works well,is worth promoting an effective treatment.