[Laryngeal function preservation in the surgical treatment of cervical esophageal carcinoma]

To study the indication and the methods of hypopharyngeal and esophageal reconstruction in the surgical treatment of cervical esophageal carcinoma with laryngeal function preservation. To explore the reasons of err inhaling after gastric-pharyngeal anastomosis and its prevention and treatment.

Clinical data of nine patients who underwent surgical treatment of cervical esophageal carcinoma with laryngeal function preservation from 1998 to 2006 were analyzed retrospectively. The patients without preoperative hoarseness included two cases of pure cervical esophageal carcinoma, six cases of cervical esophageal carcinoma involved hypopharynx and one cases of cervical-thoracic esophageal poly primary malignant carcinoma. Eight patients were carried out total laryngeal function preservation and one patient was carried out partial laryngeal function preservation. The methods of hypopharyngeal and cervical esophageal reconstruction included gastric-pharyngeal anastomosis (seven patients), free forearm flap (one patient) and pectoralis major myocutaneous flap (one patient).

Good laryngeal function in four patients, moderate laryngeal function in two patients and bad laryngeal function in three patients. Everyone in seven patients underwent gastric-pharyngeal anastomosis had a very degree of gastric countercurrent, temporalitive disappearance of cough reflex and err inhaling, five of them laryngeal paralysis. The higher anastomosis gob, the heavier err inhaling. One patient with free forearm flap died of lethal haemorrhage. One patient with pectoralis major myocutaneous flap occurred anastomosis gob stricture.

Patients with pure cervical esophageal carcinoma and cervical esophageal carcinoma involved hypopharynx less than 1 cm from the entrance of esophagus are feasible to undergo total laryngeal function preservation operation, while elder patients with cervical esophageal carcinoma involved hypopharynx more than 1 cm from the entrance of esophagus are feasible to undergo partial laryngeal function preservation operation or no laryngeal function preservation operation instead of total laryngeal function preservation operation. Err inhaling is nearly relevant to the disorder of deglutition function of the pharynx-esophagus and err inhaling prevention function of the larynx.