13. Kết quả phẫu thuật ung thư hạ họng giai đoạn III, IVA, IVB xâm lấn thực quản có tạo hình bằng vạt tự do hỗng tràng
Nội dung chính của bài viết
Tóm tắt
Ung thư hạ họng xâm lấn thực quản là một tổn thương ít gặp trong các ung thư vùng hạ họng. Điều trị cần đa mô thức trong đó phẫu thuật là phương pháp quan trọng. Nghiên cứu của chúng tôi gồm 30 bệnh nhân ung thư hạ họng giai đoạn III, IVA và IVB có xâm lấn miệng thực quản hoặc thực quản cổ được phẫu thuật và có tạo hình bằng vạt tự do hỗng tràng tại Bệnh viện K từ tháng 10/2020 đến tháng 3/2024. Kết quả cho thấy hay gặp nhất khối u xuất phát từ xoang lê và thành sau hạ họng chiếm 40% cho mỗi vị trí, tiếp đó là u vùng sau nhẫn phễu. Cắt thực quản cổ thanh quản - hạ họng toàn phần là loại phẫu thuật thực hiện nhiều nhất chiếm 90%. 100% vạt tự do hỗng tràng sống trong đó có 3,4% bệnh nhân vạt hoại tử 1 phần. Rò ống họng sau mổ chiếm 3,4%, không có biến chứng tại vùng bụng. 66,7% bệnh nhân ăn trở lại đường miệng sau 10 ngày và 30% ăn sau 14 ngày.
Chi tiết bài viết
Từ khóa
Ung thư hạ họng, vạt tự do hỗng tràng
Tài liệu tham khảo
1. Chan JY, Wei WI. Current management strategy of hypopharyngeal carcinoma. Auris, nasus, larynx. Feb 2013; 40(1): 2-6. doi:10.1016/j.anl.2011.11.009.
2. Henrys C, Slaughter T, Bernard A, Perry C, Porceddu S, Panizza B. Primary pharyngolaryngectomy with jejunal free flap reconstruction: a single centre’s evolving experience. ANZ journal of surgery. Oct 2020; 90(10): 1965-1969. doi:10.1111/ans.15930.
3. Takes RP, Strojan P, Silver CE, et al. Current trends in initial management of hypopharyngeal cancer: the declining use of open surgery. Head & neck. Feb 2012; 34(2): 270-81. doi:10.1002/hed.21613.
4. Habib A. Management of advanced hypopharyngeal carcinoma: systematic review of survival following surgical and non-surgical treatments. The Journal of laryngology and otology. May 2018; 132(5): 385-400. doi:10.1017/s0022215118000555.
5. Wei WI, Chan JYW. Surgical Treatment of Advanced Staged Hypopharyngeal Cancer. Advances in oto-rhino-laryngology. 2019; 83:66-75. doi:10.1159/000492312.
6. Lei DP, Pan XL, Xu FL, et al. [Surgical treatment of hypopharyngeal cancer with cervical esophageal invasion]. Zhonghua er bi yan hou tou jing wai ke za zhi = Chinese journal of otorhinolaryngology head and neck surgery. Sep 2005; 40(9): 691-5.
7. Perez-Smith D, Wagels M, Theile DR. Jejunal free flap reconstruction of the pharyngolaryngectomy defect: 368 consecutive cases. Journal of plastic, reconstructive & aesthetic surgery: JPRAS. Jan 2013; 66(1): 9-15. doi:10.1016/j.bjps.2012.08.033.
8. Seidenberg B, Hurwitt ES. Immediate reconstruction of the cervical esophagus by a revascularized isolated jejunal segment. Surgical forum. 1958; 9: 413-6.
9. Longmire WP, Jr. A modification of the Roux technique for antethoracic esophageal reconstruction. Surgery. Jul 1947; 22(1): 94-100.
10. Bradley PJ. Symptoms and Signs, Staging and Co-Morbidity of Hypopharyngeal Cancer. Advances in oto-rhino-laryngology. 2019; 83: 15-26. doi:10.1159/000492304.
11. Hoffman HT, Karnell LH, Shah JP, et al. Hypopharyngeal cancer patient care evaluation. The Laryngoscope. Aug 1997; 107(8): 1005-17. doi:10.1097/00005537-199708000-00001.
12. Jones RF. The Paterson-Brown Kelly syndrome. Its relationship to iron deficiency and postcricoid carcinoma. I. The Journal of laryngology and otology. Jun 1961; 75:529-43.
13. Kirchner JA. Pyriform sinus cancer: a clinical and laboratory study. The Annals of otology, rhinology, and laryngology. Nov-Dec 1975; 84(6): 793-803. doi:10.1177/000348947508400611.
14. Spector JG, Sessions DG, Emami B, et al. Squamous cell carcinoma of the pyriform sinus: a nonrandomized comparison of therapeutic modalities and long-term results. The Laryngoscope. Apr 1995; 105(4 Pt 1): 397-406. doi:10.1288/00005537-199504000-00012.
15. Ho CM, Ng WF, Lam KH, Wei WJ, Yuen AP. Submucosal tumor extension in hypopharyngeal cancer. Archives of otolaryngology--head & neck surgery. Sep 1997; 123(9): 959-65. doi:10.1001/archotol.1997.01900090073010.
16. Mauramati S, Morbini P, Ferrario G, et al. Morphological analysis of ischemia-reperfusion injury in a cold ischemia model of jejunal free flap for hypopharyngeal reconstruction. Journal of plastic, reconstructive & aesthetic surgery : JPRAS. Jan 2020; 73(1): 103-110. doi:10.1016/j.bjps.2019.07.004.
17. Nakatsuka T, Harii K, Asato H, Ebihara S, Yoshizumi T, Saikawa M. Comparative evaluation in pharyngo-oesophageal reconstruction: radial forearm flap compared with jejunal flap. A 10-year experience. Scandinavian journal of plastic and reconstructive surgery and hand surgery. Sep 1998; 32(3): 307-10. doi:10.1080/02844319850158651.
18. Pegan A, Rašić I, Košec A, et al. Type II hypopharyngeal defect reconstruction - a single institution experience. Acta clinica Croatica. Dec 2018; 57(4): 673-680. doi:10.20471/acc.2018.57.04.10.
19. Sharp DA, Theile DR, Cook R, Coman WB. Long-term functional speech and swallowing outcomes following pharyngolaryngectomy with free jejunal flap reconstruction. Annals of plastic surgery. Jun 2010; 64(6): 743-6. doi:10.1097/SAP.0b013e3181af3019.
20. Chan JY, Chow VL, Chan RC, Lau GI. Oncological outcome after free jejunal flap reconstruction for carcinoma of the hypopharynx. European archives of oto-rhino-laryngology: official journal of the European Federation of Oto-Rhino-Laryngological Societies (EUFOS) : affiliated with the German Society for Oto-Rhino-Laryngology - Head and Neck Surgery. Jul 2012; 269(7): 1827-32. doi:10.1007/s00405-011-1836-z.
2. Henrys C, Slaughter T, Bernard A, Perry C, Porceddu S, Panizza B. Primary pharyngolaryngectomy with jejunal free flap reconstruction: a single centre’s evolving experience. ANZ journal of surgery. Oct 2020; 90(10): 1965-1969. doi:10.1111/ans.15930.
3. Takes RP, Strojan P, Silver CE, et al. Current trends in initial management of hypopharyngeal cancer: the declining use of open surgery. Head & neck. Feb 2012; 34(2): 270-81. doi:10.1002/hed.21613.
4. Habib A. Management of advanced hypopharyngeal carcinoma: systematic review of survival following surgical and non-surgical treatments. The Journal of laryngology and otology. May 2018; 132(5): 385-400. doi:10.1017/s0022215118000555.
5. Wei WI, Chan JYW. Surgical Treatment of Advanced Staged Hypopharyngeal Cancer. Advances in oto-rhino-laryngology. 2019; 83:66-75. doi:10.1159/000492312.
6. Lei DP, Pan XL, Xu FL, et al. [Surgical treatment of hypopharyngeal cancer with cervical esophageal invasion]. Zhonghua er bi yan hou tou jing wai ke za zhi = Chinese journal of otorhinolaryngology head and neck surgery. Sep 2005; 40(9): 691-5.
7. Perez-Smith D, Wagels M, Theile DR. Jejunal free flap reconstruction of the pharyngolaryngectomy defect: 368 consecutive cases. Journal of plastic, reconstructive & aesthetic surgery: JPRAS. Jan 2013; 66(1): 9-15. doi:10.1016/j.bjps.2012.08.033.
8. Seidenberg B, Hurwitt ES. Immediate reconstruction of the cervical esophagus by a revascularized isolated jejunal segment. Surgical forum. 1958; 9: 413-6.
9. Longmire WP, Jr. A modification of the Roux technique for antethoracic esophageal reconstruction. Surgery. Jul 1947; 22(1): 94-100.
10. Bradley PJ. Symptoms and Signs, Staging and Co-Morbidity of Hypopharyngeal Cancer. Advances in oto-rhino-laryngology. 2019; 83: 15-26. doi:10.1159/000492304.
11. Hoffman HT, Karnell LH, Shah JP, et al. Hypopharyngeal cancer patient care evaluation. The Laryngoscope. Aug 1997; 107(8): 1005-17. doi:10.1097/00005537-199708000-00001.
12. Jones RF. The Paterson-Brown Kelly syndrome. Its relationship to iron deficiency and postcricoid carcinoma. I. The Journal of laryngology and otology. Jun 1961; 75:529-43.
13. Kirchner JA. Pyriform sinus cancer: a clinical and laboratory study. The Annals of otology, rhinology, and laryngology. Nov-Dec 1975; 84(6): 793-803. doi:10.1177/000348947508400611.
14. Spector JG, Sessions DG, Emami B, et al. Squamous cell carcinoma of the pyriform sinus: a nonrandomized comparison of therapeutic modalities and long-term results. The Laryngoscope. Apr 1995; 105(4 Pt 1): 397-406. doi:10.1288/00005537-199504000-00012.
15. Ho CM, Ng WF, Lam KH, Wei WJ, Yuen AP. Submucosal tumor extension in hypopharyngeal cancer. Archives of otolaryngology--head & neck surgery. Sep 1997; 123(9): 959-65. doi:10.1001/archotol.1997.01900090073010.
16. Mauramati S, Morbini P, Ferrario G, et al. Morphological analysis of ischemia-reperfusion injury in a cold ischemia model of jejunal free flap for hypopharyngeal reconstruction. Journal of plastic, reconstructive & aesthetic surgery : JPRAS. Jan 2020; 73(1): 103-110. doi:10.1016/j.bjps.2019.07.004.
17. Nakatsuka T, Harii K, Asato H, Ebihara S, Yoshizumi T, Saikawa M. Comparative evaluation in pharyngo-oesophageal reconstruction: radial forearm flap compared with jejunal flap. A 10-year experience. Scandinavian journal of plastic and reconstructive surgery and hand surgery. Sep 1998; 32(3): 307-10. doi:10.1080/02844319850158651.
18. Pegan A, Rašić I, Košec A, et al. Type II hypopharyngeal defect reconstruction - a single institution experience. Acta clinica Croatica. Dec 2018; 57(4): 673-680. doi:10.20471/acc.2018.57.04.10.
19. Sharp DA, Theile DR, Cook R, Coman WB. Long-term functional speech and swallowing outcomes following pharyngolaryngectomy with free jejunal flap reconstruction. Annals of plastic surgery. Jun 2010; 64(6): 743-6. doi:10.1097/SAP.0b013e3181af3019.
20. Chan JY, Chow VL, Chan RC, Lau GI. Oncological outcome after free jejunal flap reconstruction for carcinoma of the hypopharynx. European archives of oto-rhino-laryngology: official journal of the European Federation of Oto-Rhino-Laryngological Societies (EUFOS) : affiliated with the German Society for Oto-Rhino-Laryngology - Head and Neck Surgery. Jul 2012; 269(7): 1827-32. doi:10.1007/s00405-011-1836-z.