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Reconstruction with a free jejunal autograft after circumferential pharyngo-laryngectomy for cancer of the hypopharynx and cervical esophagus is generally an accepted method. In our department, we used atypical reconstruction by two-segment anastomosis with a single vascular pedicle and (three end-to-end) anastomosis with intersected jejunum in the mid part of graft, as well as typical reconstruction with end-to-end anastomosis at the oral and esophageal ends. In those atypical anastomoses, two-segment reconstruction was used for the patients with high pharyngeal resection by a patch segment for lateral defect of the oropharynx and a circumferential end-to-end segment. An intersected reconstruction in the mid part was used when the jejunum was relaxing after microvascular anastomosis. To clarify the anastomotic viability of these atypical reconstructions, the day of oral intake after surgery and the cause of delay were investigated for the above three methods of reconstruction, during the period from Oct. 1999 to Mar. 2007 in our department. Fifty-six patients were included in this study, 56 were male and 9 were female, age range 48-89 (average 64.4) years. The average time point of the start of oral intake was 15.1 days after surgery in all cases. In the typical reconstruction (n=52), four cases were delayed and the causes of delay were pharyngeal-end leakage, ileus, subcutaneous hemorrhage and necrosis of cervical skin, respectively. In the two-segment reconstruction (n=8), three cases were delayed and the causes of delay were esophageal-end leakage, ileus and neck abscess. In the intersected reconstruction (n=5), one case was delayed with ileus. These results suggest that atypical reconstruction might not increase anastomotic leakage even though the points of anastomosis increased, and that atypical reconstruction itself might be a viable method of reconstruction.
- 特定非営利活動法人 日本頭頸部外科学会の論文
特定非営利活動法人 日本頭頸部外科学会 | 論文
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