Non-thoracotomy esophagectomy, cervical esophagogastric anastomosis

There are two methods for non-open thoracic esophagectomy, one is invert-stripping of the esophagus without thoracotomy; the other is blunt transmediastinal esophagectomy without thoracotomy. In both methods, the esophagus is removed and the stomach is lifted through the esophageal bed to the neck and the esophagus. Treating diseases: esophageal cancer Indication 1. Lower pharyngeal or cervical esophageal cancer. 2. Esophageal carcinoma in situ or early cancer. 3. More limited early cardia cancer. Preoperative preparation 1. Strengthen nutrition and give a high-fat, high-protein diet. Due to the difficulty of swallowing, it often affects the general condition of the patient. A small number of patients can increase their body weight by 2 to 3 kg within 2 weeks after completing preoperative radiotherapy to relieve the obstruction. 2. Help patients increase their activity to enhance their physical fitness, practice urination in bed and effective cough. 3. Strengthen brushing your mouth and pay attention to oral hygiene. 4. Severe obstruction, starting from 3 days before surgery, use the catheter to wash the esophagus before going to sleep at night. 5. Prepare the skin 1 day before surgery. 6. Enema one time before surgery, giving sleeping pills. The stomach tube was taken on the morning of the operation, and the medicine was administered before the injection. Surgical procedure Non-open thoracic esophagus (1) Incision: the anterior border of the left sternocleidomastoid and the median incision of the upper abdomen. (2) Surgery can be performed in the neck group and the abdomen group. In the lower pharyngeal and cervical esophageal cancer, the neck group can be used for neck incision exploration to determine the tumor can be removed, the abdominal group is open, and the stomach is freed according to the conventional method. Tumor cancer, you can first exploratory laparotomy, to determine the tumor can be removed after the neck incision, free cervical esophagus. After the esophagus of the stomach and neck is free, the esophagus in the thoracic esophagus is removed by esophagus. The method of extraction is from the lower to the esophagus in the lower neck or from the upper to the intestine. After the large gauze enlarges the esophageal bed and compresses the esophageal bed to stop bleeding, the stomach is lifted through the esophageal bed to the neck and the esophagus or hypopharynx. The pharyngeal anastomosis emphasizes double suture, that is, the first layer is the mucosal layer, and the second layer is the gastric musculoskeletal layer to the pharyngeal muscle layer. Esophagogastric anastomosis can be a single-layer wide-edge suture or two-layer anastomosis. 2. Non-thoracotomy through the mediastinum blunt esophagectomy (1) Incision: the same as "non-opening esophagus varus extraction". (2) Left sternocleidomastoid incision, free cervical esophagus. At the same time, the upper abdomen incision, free abdomen esophagus, and traction with a cloth belt, enlarge the esophageal hiatus, the right hand through the hiatus into the posterior mediastinum, separate the esophagus along the esophageal bed to reach the tracheal plane, and the fingers are separated from the neck along the esophagus. The upper and lower fingers can meet at the ridge, so that the esophagus is completely free. The esophagus was cut at the neck, the distal end was sutured and pulled downward from the abdominal cavity, and a large gauze was introduced to compress the esophageal bed to stop bleeding. After the stomach is completely free, it is cut at the cardia, and the stomach is lifted through the esophageal bed until the neck and the esophagus are anastomosed. The anastomosis method is the same as "the esophagus candied the esophagus neck anastomosis".