Free jejunum or colon transplantation to reconstruct the laryngopharynx

Microsurgical small vessel anastomosis, free jejunal or colonic segment reconstruction of the laryngeal and cervical esophagus, with the length of the pharyngeal and cervical esophageal defects is limited, blood supply is abundant, reliable materials, completed in the first phase of surgery The advantage is beneficial to the recovery of the throat function and swallowing function. Treatment of diseases: congenital esophageal stricture, nasopharyngeal carcinoma Indication 1. Laryngeal cancer involving the cervical esophagus after extensive resection. 2. The recovery of traumatic laryngeal and cervical esophageal defects. 3. Corrosive laryngeal and cervical esophageal stricture atresia. Preoperative preparation Laryngoscopy, esophagoscopy, x-ray swallowing photos, ct scans, etc. should be performed before surgery to determine the extent of cancer. Enema preparation is required before surgery. Surgical procedure The neck and abdomen were performed simultaneously. 1. The surgical method of resection of the neck according to the conventional laryngeal and cervical esophageal cancer. However, when removing the lesion, care should be taken to protect the blood vessels in the neck graft. Generally, the superior thyroid artery and the external jugular vein are preferred. The lower thyroid artery, the transverse cervical artery, the external maxillary artery, the external carotid artery, the facial vein, and the thyroid gland may also be selected. Upper vein, internal jugular vein, etc. The selected blood vessels were carefully dissected, freed, cut at the appropriate site, distally ligated, and clamped at the proximal end with a small blood vessel clamp. 2. The abdomen adopts a midline incision in the umbilicus. After opening the abdominal cavity, the mesenteric artery and vein suitable for anastomosis with the neck blood vessel are selected. It is suitable to be 20 to 30 cm away from the ligament of the jejunum. Because of the rich vascular arch communication between the jejunal mesenteric vessels, ligation of the vascular trunk at the proximal end of the vascular arch does not affect the blood flow of the intestine. Therefore, the mesenteric vessels can be selected according to the needs, and the caliber is also close to the vessel diameter of the neck receiving region. , the anastomosis is more convenient. It is also possible to use a ligation section for transplantation, but the anastomosis between the colonic arteries is poor, and the mesenteric artery should be carefully selected. The intestine and the esophagus belong to the digestive tract, the tissue structure is similar, and the gland can secrete intestinal fluid, which makes the mucous membrane lubricated, which is beneficial to the recovery of swallowing function. 3. After sealing the mesenteric root with 1% procaine, the mesenteric artery and vein were separated and dissected from the two layers of the peritoneum. According to the length of the laryngeal and cervical esophageal defects, the intestines were slightly longer than the length of the defect, and the two ends of the jejunum were anastomosed to restore the intestinal tract. 4. When the neck surgery is finished, select the appropriate blood vessels in the recipient area, cut off the mesenteric vascular pedicle, and immediately infuse the mesenteric artery with 0.1% 4°C heparin saline about 40~60ml until the mesenteric vein clarifies. The bowel becomes white. The isolated intestine is irrigated with 0.1% benzalkonium bromide solution or neomycin solution, but the mesangial blood vessels should not be immersed in the benzalkonium bromide solution to avoid irritating damage. 5. Transplanting the free intestine into the laryngeal and cervical esophageal defect area, the intestine should be placed in the direction of peristalsis, and the mesenteric artery, vein and superior thyroid artery, external jugular vein After the anastomosis, the blood vessel clamp is removed, that is, the anastomotic artery and the mesenteric small artery are recovered, the vein filling is good, and the intestinal tube recovers the intestinal peristalsis. The upper and lower mouths of the intestine segment were respectively anastomosed with the end of the laryngeal and cervical segment of the esophagus.