喉摘術後胃癌患者に対して胃切除と遊離回盲部パッチを用いた音声再建を同時に行った１例

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  • A CASE OF A SECONDARY VOICE RESTORATION USING A FREE ILEOCECAL PATCH GRAFT FOLLOWING A DISTAL GASTRECTOMY FOR EARLY GASTRIC CANCER IN A PATIENT UNDERGONE A LARYNGECTOMY

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We succeeded in a voice restoration using a free ileocecal patch graft following a distal gastrectomy for early gastric cancer in a patient undergone a laryngectomy.<br> A 65-year-old woman who had undergone a laryngectomy for thyroid cancer with laryngeal invasion 2 years earlier was admitted to the hospital because of early gastric cancer. She had tried hard to get voice rehabilitation of esophageal speech, but she could not speak during the past 2 years. To this patient, a distal gastrectomy and a free ileocecal patch transplantation were performed simultaneously. The new surgical procedures were as follows. An ileocecal segment was harvested and placed in the neck, and the feeding pedicle was anastomosed to the cervical vessels using a microvascular technique. A new orifice was made at the anterior wall of the hypopharynx and covered with the trimmed ileocecal patch. An ileumend of the graft was anastomosed to the permanent tracheostomy in an end-to-side fashion. This is the only procedure for secondary voice restoration using a free intestinal graft, but its disadvantages includes the necessity of harvesting an ileocecal segment under laparotomy. In this case we were able to obtain informed consent from the patient, who had lost the larynx, to receive laparotomy for a secondary voice restoration as well as for gastric cancer. These procedures brought about not only a cure of gastric cancer but also voice restoration. This is the 2nd case of secondary voice restoration in Japan.

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