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华西医学  2011 

游离空肠移植术后再手术时对血管蒂的保护

, PP. 372-374

Keywords: 下咽癌,空肠游离将植,重建,复发

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Abstract:

【】 目的 观察全喉全下咽切除术后空肠游离移植术二次手术时同时保留动静脉血管蒂或仅保留动脉血管蒂时对移植组织的影响。  方法 回顾分析2002年1月-2009年12月4例下咽癌行全喉全下咽切除术空肠游离移植术术后8~18个月因颈部转移灶出现而需再行手术患者的临床资料,其中3例行根治性颈清扫,1例行局部包块扩大切除术。2例同时保留动静脉蒂,2例仅保留动脉蒂。 结果 4例术后临床Ⅰ期愈合。保留动静脉蒂者吞咽功能与术前无异。仅保留动脉蒂者术后1个月仍有颈中份的明显隐痛,胃肠造影移植空肠段的蠕动明显减弱,吞咽固体食物时自觉较术前缓慢。 结论 再次手术时保留血管蒂对于保持空肠移植段的活力具有重要的意义。【Abstract】 Objective Toobservetheeffectofkeepingarteriovenousorvenouspediclesduringthesecondfreejejunaltransplantationaftertotallaryngopharyngectomyonthetransplantedtissues. Methods FromJanuary2002toDecember2009,fourpatientsunderwenttotallaryngopharyngectomyandfreejejunal.But8-18monthslater,thepatientsunderwentanotheroperationbecauseofrecurrentmetastaticmassintheipsilateralnecksideofanastomosis;inwhomthreeunderwentradicalneckdissectionandoneunderwentlocalenlargedmassresection.Inthefourpatients,twohadarteriovenouspediclesremainedandanothertwokeptonlyvenouspedicles. Results Allofthefourpatientsexperiencedfirst-stagehealing.Thedeglutitivefunctioninthetwopatientswhohadreceivedthearteriovenouspediclespreservationdidn’tdiffermuchfromthatbeforetheoperation.Whilevagueanguishintheanteriorregionoftheneck,weakperistalsisofthetransplantedjejunum,alittlediscomfortandslowswallowingwerefoundinanothertwopatients. Conclusion Keepingvascularpediclesduringre-operationhelpsmaketheactivityofthetransplantedjejunum.

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