Surgical Reconstruction For Defects After Hypopharygeal Carcinoma Resection

Objective To explore and evaluate the reparative methods after hypopharygeal carcinoma resection.Method Clinical date of 80 cases of defects following hypopharygeal carcinoma resection were analysed from January 2006 to December 2011.Among them,28 cases were performed with direct suture rehabilitation,18 cases with pectoralis major myocutaneous flap,16 cases with strap muscular flap and thyroid cartilage perichonrium flap, 11 cases with combined laryngotr- acheal flap,6 cases with gastric pull-up,1 cases with free jejunal graft.Result There was no statistically significant differenc between the direct suture rehabilitation group and the tissue transplantation group on age and mean hospitalization.In patients with direct suture rehabilitation, twenty-three(85.2%)patients were able to take oral nutrition except one case no rehabilitation for repair difficult. Successful deglutition rate was 76.9%(40/52)for the tissue transpiration group. Stricture rates were 33.3% and 22.2% on PMMF(pectoralis major myocutaneous flap) and ATF(adjacent tissue flap).Seven cases with visceral flap had better swallowing.Twenty(25%) patients developed a postoperative pharyngocutaneous fistula,in which 10 cases were treated by dressing changes to heal,and the rest cases by diffent methods to repaire. Intraoperative damage of trachea membrane happened in 2 cases,including 1 case of repair success,1 case of giving up treatment.1case of abdominal incision dehiscence occurred 13 days after operation,but suture successfully again.36 cases were treated with laryngeal functions preserved and restored the respiratory function and pronunciation,in which 28 cases of tracheostomy tube removal after surgery were about 3 months.25 cases aged above 60 with laryngeal functions preserved developed the following comlplications,including 2 cases of serious choking cough,2 cases of aspiration and pulmonary infection,3 cases of laryngostenosis.The overall 1-year,3-year,5-year survival rates of the group were 62.5%、40.7%、32.9%, respectively.The survival rates between the group with laryngeal functions preserved and the other group has no statistically significant differenc.Conclusion The choice of the ways of hypopharygeal carcinoma defect repair is according to the tumor site, the size of defect and patient general condition. ATF(adjacent tissue flap)is a priority. Laryngotracheal flap combined other ATF is particularly suitable for elderly and the patient with severe pulmonary dysfunction.For circumferential defects, visceral flap is a priority in swallowing recovery. For non-circumferential defects, PMMF and ATF are the most widely used means of repair.