奇譽【 廖倩茹、林沁梅、林彩勤 】與【光田劉耿僚主任】的 醫療中心

作者: 陸希平(Shi-Ping Luh);廖倩茹(Janie Liao);蔡日新(Nis-Shin Sai);劉耿僚(Ken-Liao Liu);蔡宗博(Tsong-Po Tsai);周明智(Ming-Chih Chou);蘇劍秋(Jian-Chou Su)
針對下咽癌的最適合療法決定於腫瘤的分期。對於早期腫瘤使用放射治療或外科治療其效果差不多。但對於局部侵犯性晚期腫瘤而言，廣泛性手術切除加術後放射治療是最佳的選擇。對於這種疾病如何作廣泛性切除及重建的方式，對外科醫師來說仍是一個極大的挑戰。在這篇文章中我們將報告兩位局部侵犯性下咽癌使用外科廣泛切除（咽侯及頸部食道切除及兩側頸廓清術）及使用長胃管重建術。手術進行均成功，但其中一位病人（病例1）因考慮開刀時機已晚而不幸仍因局部復發而死亡。我們認為廣泛性下咽部切除及使用長胃管重建是十分安全及有效的手術，掌握手術時機及手術前之癌症分期均會影響治療的預後。
Optimal therapy for hypopharyngeal carcinoma depends on the stage of disease that therapy is begun. Radiotherapy and surgery get similar results for early-stage disease. For advanced-stage disease, however, radical surgery followed by radiotherapy is the treatment of choice. Extensive malignant tumors of the hypopharynx continue to challenge surgeons with respect to both type and extent of resection as well as type of reconstruction. Herein, we reported on two patients with advanced stage hypopharyngeal carcinoma who underwent extensive resection and gastric tube reconstruction. The extent of resection included the hypopharynx, larynx, cervical esophagus, and bilateral modified radical neck dissection. The gastric tube was used for alimentary tract reconstruction, and permanent tracheostomy was used for airway reconstruction. The postoperative course in both was uneventful, both regaining satisfactory ability to swallow.. One of our patients, unfortunately, died of neck recurrence ten months after operation. We conclude that reconstructing the hypopharynx with gastric tube is a reliable and safe method, though its clinical outcome depends mainly on the stage of the tumor at the time of reconstruction.