Oropharyngeale Rekonstruktion mittels freiem Jejunumtransplantat nach Tumor- und Stenosenresektion: Analyse von 53 Fällen

Abstract

The surgical therapy of oropharyngeal carcinoma by means of a free jejunum graft is an established procedure. The application of a monitor segment for postoperative flow control turned out to be a reasonable modification. In this study, we examine the results over a period of 16 years retrospectively. Between 1988 and 2004, 53 patients underwent oropharyngeal reconstructions by means of 58 free jejunum grafts at the clinic for reconstructive surgery in cooperation with the clinic for otorhinolaryngology. All patients were examined postoperatively with the help of a small jejunum loop in the function of a monitor segment to survey flap vitality. Between the 7th and 11th postoperative day the patients were administered Gastrografin to evaluate oesophagojejunal anastomoses. The survival ratio of the transplants in this series amounted to 90.6 %. All anastomoses were initially passable and leak-proof. After a complete loss of the first graft, five patients were successfully reconstructed with a second jejunum graft. In one patient, the vessel anastomoses had to be revised. In two patients, newly formed stenoses were postoperatively treated with a bougie during hospitalisation. In four patients, fistula formation was detected in the follow-up examination. Substantial advantages of the free jejunum graft compared to other alternative free or local tissue transfers are the excellent functional results, the simple local tumour monitoring and the low complication rate.