대한두경부종양학회지 (Korean Journal of Head & Neck Oncology)

  • 제24권1호
  • /
  • Pages.43-46
  • /
  • 2008
  • /
  • 1229-5183(pISSN)
  • /
  • 2586-2553(eISSN)
대한두경부종양학회 (The Korean Society for Head and Neck Oncology)
권호 표지

하인두암에서 후두인두 및 경부 식도 전 적출술 후 유리 공장 이식술의 합병증에 대한 후향적 분석

Retrograde Analysis of Complications of Jejunal Free Flap after Total Pharyngo-Laryngo-Cervical Esophagectomy in Advanced Hypopharyngeal Cancer Treatment

  • 민현진 (연세대학교 의과대학 이비인후과학교실) ;
  • 현동우 (연세대학교 의과대학 이비인후과학교실) ;
  • 김영호 (연세대학교 의과대학 이비인후과학교실) ;
  • 최은창 (연세대학교 의과대학 이비인후과학교실) ;
  • 김광문 (연세대학교 의과대학 이비인후과학교실) ;
  • 김세헌 (연세대학교 의과대학 이비인후과학교실)
  • Min, Hyun-Jin (Department of Otolaryngology and Head & Neck Surgery, Yonsei University College of Medicine) ;
  • Hyun, Dong-Woo (Department of Otolaryngology and Head & Neck Surgery, Yonsei University College of Medicine) ;
  • Kim, Young-Ho (Department of Otolaryngology and Head & Neck Surgery, Yonsei University College of Medicine) ;
  • Choi, Eun-Chang (Department of Otolaryngology and Head & Neck Surgery, Yonsei University College of Medicine) ;
  • Kim, Kwang-Moon (Department of Otolaryngology and Head & Neck Surgery, Yonsei University College of Medicine) ;
  • Kim, Se-Heon (Department of Otolaryngology and Head & Neck Surgery, Yonsei University College of Medicine)
  • 발행 : 2008.05.31
PDF 다운로드
⟨ 이전 논문 다음 논문 ⟩

초록

진행된 하인두암의 수술 후 시행한 유리 공장 이식술을 시행한 본원의 경험에서 수술 후 누공 형성, 수술 부위 협착 등의 다양한 합병증과 그 치료방법을 경험하였다. 수술 방법에 있어서 한 개의 동맥과 정맥을 연결하였고 이식한 혈관의 혈전에 의한 이식 실패는 없었다. 수술 후 연하 기능에 있어서 영향을 주는 가장 중요한 요인은 이식 부위 협착이 었으며 협착의 치료 결과에 따라 술 후 연하 기능의 회복에 차이가 있음을 확인하였다.

Hypophayngeal cancers are usually diagnosed in advanced stages and in many cases, they need total pharyngocervical esophagectomy and surgical reconstruction. Among many surgical reconstructive methods, jejunal free flap has anatomical and functional advantages such as tubed nature, peristaltic activity, excellent blood supply. In this study we analysed the surgical procedure and complications of jejunal free flap after total pharyngo-cervical esophagectomy. 20 cases performed jejunal free flap from 1995 to 2007 at Severance Hospital were reviewed. According to time of onset, early and late complications were reviewed. Surgical procedure was reviewed with operation record. Oral diet tolerance was reviewed on the basis of pharyngogram and subjective symptoms. The most common complication was stricture, and it occurred in 40% of cases and 63% of them were managed with conservative care. As early complication, fistula formation was all managed with conservative care. Oral feeding tolerance after jejunal free flap was 65% and 7 patients were tolerable to general diet. In our study, stricture was the most common complication and its management is important in post op oral diet tolerance.

키워드

참고문헌

  1. Hoffman HT, Karnell LH, Shah JP, et al: Hypopharynageal cancer patient care evaluation. Laryngoscope. 1997;107(8):1005-1017 https://doi.org/10.1097/00005537-199708000-00001
  2. Gluckman JL, Weissler MC, McCafferty G, et al: Partial vs. total esophagectomy for advanced carcinoma of the hypopharynx. Arch Otolaryngol Head Neck Surg. 1987;113(1):69-72 https://doi.org/10.1001/archotol.1987.01860010073018
  3. Peracchia A, Bardini R, Ruol A, Castoro E, Tiso E, Asolati M: Cancer of the hypopharynx and cervical esophagus. Role and limits of the surgical treatment. Chirurgie. 1990;160(4-):351-358
  4. Avci C, Avtan L: Reconstruction of the hypopharynx and cervical esophagus with free jejunal graft with double pedicle. Chirurgie. 1991;117(8):653-660
  5. Haughey BH: The jejunal free flap in oral cavity and pharyngeal reconstruction. Otolaryngologic Clinics of North America. 1994; 27(6):1159-1170
  6. Yamamoto Y, Nohira K, Schintomi Y, et al: Mesenteric flap in free jejunal transfer: a versatile technique for head and neck reconstruction. Head & Neck. 1995;17(3):213-218 https://doi.org/10.1002/hed.2880170308
  7. Julieron M, Germain MA, Schwaab G, et al: Reconstruction with free jejunal graft after total circular pharyngolaryngectomy. 73 cases. Ann Otolaryngol Chir Cervicofac. 1996;113(5):269-275
  8. Marks SC, Steiger Z: Combined pectoralis flap and gastric pullup for pharyngeal reconstruction. Head & Neck. 1997;19(2):134-136 https://doi.org/10.1002/(SICI)1097-0347(199703)19:2<134::AID-HED8>3.0.CO;2-5
  9. Bradford CR, Esclamado RM, Carrol WR, Sullivan MJ: Analysis of recurrence, complications, and functional results with free jejunal flaps. Head & Neck. 1994;16(2):149-154 https://doi.org/10.1002/hed.2880160208
  10. Giovanoli P, Frey M, Schmid S, Flury R: Free jejunum transfer for functional reconstruction after tumour resection in the oral cavity and the pharynx: changes of morphology and function. Microsurgery. 1996;17(10):535-544 https://doi.org/10.1002/(SICI)1098-2752(1996)17:10<535::AID-MICR2>3.0.CO;2-P
  11. Julieron M, Germain MA, Schwaab G, et al: Reconstruction with free jejunal autograft after circumferential pharyngolaryngectomy: eighty-three cases. Ann Otol Rhinol Laryngol. 1998;107(7):581-587 https://doi.org/10.1177/000348949810700707
  12. Omura K, Misaki T, Watanabe Y, Urayama H, Hashimoto T, Matsu T: Reconstruction with free jejunal autograft after pharyngolaryngoesophagectomy. Ann Thorac Surg. 1994;57(1):112-117 https://doi.org/10.1016/0003-4975(94)90376-X
  13. Renier S, Decroocq F, Simon C: Our experience in pharyngeal reconstruction with free flaps after total circular pharyngolaryngectomy. J Fr ORL. 1996;45:21-27
  14. Marco Benazzo, Antonio Occhini: Jejunum free flap in hypopharynx reconstruction: Case series. BMC Cancer. 2002;2:13 https://doi.org/10.1186/1471-2407-2-13
  15. Mayot D, Dron K, Moermann X, Lindas P, Perrin C: Our experience of pharyngeal reconstruction with forearm flap. J Fr ORL. 1993;42:249-255
  16. Stark B, Nathanson A: The free radial forearm flap: a reliable method for reconstruction of the laryngohypopharynx after in-continuity resection. Acta Otolaryngol. 1998;118(3):419-422 https://doi.org/10.1080/00016489850183548
  17. Mutsumi Okazaki, Hirotaka Asato, Masayuki Okochi, Hirotaka Suga: One-Segment Double Vascular Pedicled Free Jejunum Transfer for the Reconstruction of Pharyngoesophageal Defects. Journal of Reconstructive Microsurgery. 2007;23(4):213-217 https://doi.org/10.1055/s-2007-981503
  18. Guler M, Isik S, Sezgin M: Pharyngoesophageal reconstruction with the tubed radial forearm free flap. Eur Arch Otorhinolaryngol. 1998;255(1):24-26 https://doi.org/10.1007/s004050050017