ÜÇ FARKLI YÖNTEM İLE SERVİKAL ÖZAFAGUS DEFEKTLERİNİN ONARIMI

Year 2005, Volume: 6 Issue: 3, 37 - 41, 01.12.2005

Eray Copcu Alper Aktaş Nazan Sivrioğlu Serdar Şen Yücel Öztan

Abstract

Servikal özafagus defektlerinin onarımı, rekonstrüktif cerrahinin en zor konularından biridir. Bu defektlerhipofarinks tümörleri ve primer servikal özafagus tümörleri sonucu gelişir. İdeal rekonstrüksiyon yönteminin,onkolojik cerrahi ile aynı seansta yapılabilir, erken fonksiyon sağlayabilir ve düşük morbidite oranına sahip birteknik olması gereklidir. Bu çalışmada üç farklı teknikle servikal özafagus onarımları, literatür bilgileriylebirlikte ayrıntılı olarak sunulmuştur. Olguların biri pektoralis major kas deri flebi, diğeri deltopektoral fleple veen son olgu da servikohumeral flep ve deri grefti ile rekonstrükte edilmiştir. Olguların tümünde oral alımı erkendönemde sağlanmıştır.Yutma fonksiyonun en erken zamanda sağlanmasının, yöntem seçiminde temel belirleyiciolduğunu düşünmekteyiz.Sonuç olarak bu çalışmada her ne kadar üç farklı yöntem, farklı cerrahların seçimi olarak sunulmuş ise de, buyöntemler kendi avantaj ve dezavantajlarına sahiptir. Deltopektoral flepde parsiyel nekroz gelişmesi,servikohumeral flebin ise geciktirme işlemine ihtiyaç duyması nedeniyle, sunulan yöntemler içinde pektoralismajor kas deri flebi ile onarım daha başarılı bunmuştur

Keywords

ozafagus rekonstruksiyonu, pektoralis major muskulokutan flep, deltopektoral flep, servikohumoral flep

Reconstruction of Cervical Esophagus Defects With Three Different Techniques

Abstract

Reconstruction of defects of the cervical esophagus is one of the most difficult tasks in reconstructive surgery. These defects are generally seen after tumors of hypopharynx and cervical esophagus. The method of reconstruction, which will be selected, therefore, must be reliable, a one-stage procedure with minimal morbidity and one that restores function in the shortest time possible. In this article, we present our experience with three different techniques: the pectoralis major musculocutaneous flap, the deltopectoral flap and a combination of cervicohumeral flap and skin grafting. Oral feeding was established early in all cases. We are of the opinion that the time for swallowing ability after operation is the one of the most important factors in determining the technique chosen for reconstruction of defects of the cervical esophagus. In conclusion, although three different techniques were presented in this study according to the surgeons choice, each technique has its own advantages and disadvantages. Since the partial necrosis in deltopectoral flap and necessity of the delay process in cervicohumeral flap were complications of the techniques, pectoralis major myo-cutaneous flap may be accepted as a more suitable reconstruction technique.

Keywords

esophagus reconstruction, pectoralis major musculocutaneous flap, deltopectoral flap, cervicohumeral flap

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