[Functional and cancerologic aspects in the use of jejunum in the ENT area].
In this article, we report about the experiences at our ENT-University Clinic in Vienna in 76 patients with free transplanted microvascularly anastomosed autologous jejunum used for reconstruction following extensive resection of mainly stage IV carcinomas in the head and neck. Jejunum was inserted as a siphon-like tube between the trachea and the hypopharynx in 43 patients primarily for restoration of speech (in 10 cases the pharynx was also reconstructed). In 33 patients, the upper digestive tract was reconstructed, as either patch or tube. They were then evaluated according to functional results of speech and swallowing, aesthetics as well as 5-year survival rates. We achieved good results in 35 speech patients (81.4%) and in 22 swallowing patients (66.6%). The aesthetic function was influenced favourably because the volume of the jejunal transplant fills up the defect in the neck after resection and creates a tolerable neck-shape. The 5-year survival of all available 54 patients was 26%, patients for speech restoration 31.7% and patients for swallowing restoration 17.5%. These results are to be considered under the aspect that patients with swallowing restoration primarily had more severe disease. Complications such as like perioperative mortality and total necrosis can be avoided by careful evaluation of the patients to be operated on. With the experiences gained from this study, we now have exact indications for the use of jejunum grafts and thus can expect very high rates of success.
Grasl
M C
MC
Universitätsklinik für Hals-Nasen-Ohrenheilkunde, Kopf-Halschirurgie Wien.
Ehrenberger
K
K
Kornfehl
J
J
Piza-Katzer
H
H
Roka
R
R
Roth
T
T
D000230:Adenocarcinoma / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D000328:Adult; D000368:Aged; D000714:Anastomosis, Surgical / Q000379:methods; D002294:Carcinoma, Squamous Cell / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D037981:Neck Dissection / Q000379:methods*; D009367:Neoplasm Staging; D010039:Otorhinolaryngologic Neoplasms / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D011183:Postoperative Complications / Q000401:mortality; D013524:Surgical Flaps / Q000379:methods* / Q000473:pathology; D015996:Survival Rate
Funktionelle und kanzerologische Aspekte bei der Verwendung von Jejunum im HNO-Bereich.