胃咽吻合术山西省肿瘤医院（０３００１３）张俊生，任保元，康秀水，李刚中下咽癌较易误诊，治疗效果差，其失败的主要原因是局部复发和颈淋巴结转移。近年来，头颈外科主要围绕原发灶切除范围，颈淋巴清扫，缺损修复材料进行探索，以求提高生存率和生存质量。我院自１９８３年３月～１９９１年３月对１３例下咽癌及３例喉癌术后复发侵犯下咽部者行全喉、全下咽切除、全食管内翻剥脱、胃代食管、胃与口咽吻合术，现报告如下：资料与结果一、一般资料：男１１例，女５例，年龄最大６９岁，最小３６岁，平均５９．２岁；肿瘤部位：原发灶位于梨状窝６例，环后３例，咽后壁４例，喉癌术后复发侵犯环后２例，侵犯梨状窝１例；病理和病变分期：１６例均为鳞状细胞癌。１３例下咽癌参照ＵＩＣＣ（１９８７年）分期，Ｔ３Ｎ２ｃＭ０１例，Ｔ４Ｎ０Ｍ０５例，Ｔ４Ｎ１Ｍ０５例，Ｔ４Ｎ２ｃＭ０２例。二、治疗方法：１６例行全喉全下咽切除，食管非开胸内翻剥脱，用胃从后上纵膈上提行胃与口咽吻合。１０例（１２侧）同期行颈淋巴清扫术，７例行甲状腺单叶切除术。５例术前曾做钴６０放射治疗，肿瘤量为４０～６０ＧＹ。并发症：咽瘘３例，腹部伤口裂开３例，胸腔积液１例。三、治疗效果：１４例恢复吞咽功能， Gastric and pharyngeal anastomosis Shanxi Provincial Cancer Hospital (030013) Zhang Junsheng, Ren Baoyuan, Kang Xiushui, Li Gang Middle hypopharyngeal cancer is more likely to be misdiagnosed and has poor therapeutic effect. The main reasons for its failure are local recurrence and cervical lymph node metastasis. In recent years, head and neck surgery has mainly focused on resection of primary lesions, cervical lymph node dissection, and defect repair materials in order to improve survival and quality of life. In our hospital from March 1983 to March 1991, 13 cases of hypopharyngeal cancer and 3 cases of recurrent laryngeal cancer recurred invading the hypopharynx underwent total laryngectomy, total hypopharyngectomy, total esophageal varus, gastroesophageal, and stomach Oropharyngeal anastomosis, now reported as follows: data and results First, general information: 11 males and 5 females, the oldest 69 years old, the youngest 36 years old, average 59.2 years old; tumor site: primary lesion located in the pear-like There were 6 cases of fossa, 3 cases of posterior ring, 4 cases of posterior pharyngeal wall, 2 cases of recurrence of laryngeal carcinoma after violation of ring, and 1 case of invading Piriformis. Pathological and pathological stages: 16 cases were squamous cell carcinoma. 13 cases of hypopharyngeal cancer were classified according to UICC (1987), T3N2cM01, T4N0M05, T4N1M05, and T4N2cM02. Second, the treatment: 16 cases of total hypopharyngectomy, total esophageal excision, non-epithelial ectropion, with the stomach from the posterior mediastinum on the mention of the stomach and oropharyngeal anastomosis. Ten patients (12 sides) underwent cervical lymph node dissection simultaneously, and 7 patients underwent single lobectomy. Five patients received cobalt 60 radiation therapy before surgery and the tumor volume was 40 to 60 GY. Complications: 3 cases of pharyngeal fistula, 3 cases of abdominal wound dehiscence, and 1 case of pleural effusion. Third, the treatment effect: 14 cases to restore swallowing function,