Extended cervical esophagotomy

The pharyngeal esophageal diverticulum is the most common esophageal diverticulum, located proximal to the posterior pharyngeal muscle, or to the posterior wall of the pharyngeal esophageal junction above the pharyngeal muscle. There are two types of surgical treatment for the pharyngeal esophageal diverticulum, namely, a simple pharyngeal myotomy and a one-stage pharyngoesophageal diverticulectomy. In addition, there is an extended (expanded) cervical cervical esophagomyotomy. Treatment of diseases: pharyngeal esophagus Indication An enlarged cervical esophageal myotomy is available for: This surgical procedure, reported by Orringer and Mich in 1980, is primarily applicable to the following patients. 1. Patients with pharyngeal esophageal diverticulum complicated with pharyngeal muscle dysfunction (dysphagia). 2. Recurrence after pharyngeal esophagectomy. 3. Causes of swallowing dysfunction caused by other causes, such as dysphagia after a cerebrovascular accident, symptomatic thoracic esophageal fistula or polymyositis. Surgical procedure 1. Incision: A circular oblique incision is made parallel to the anterior border of the left sternocleidomastoid with the annular cartilage as the center, and the skin and subcutaneous tissue are cut. 2. Cut the platysma, scapula and fascia layer one by one: pull the sternocleidomastoid and carotid sheath outward, pull the trachea to the medial side; dissect the recurrent laryngeal nerve in the esophageal tracheal groove And protect it. If necessary, the thyroid thyroid or the inferior thyroid artery can be ligated. 3. Continue to separate the cervical fascia from the anterior fascia. To facilitate dissection and visualization of the cervical esophagus and diverticulum, a Hurst-Malony probe can be inserted from the nasal cavity into the cervical esophagus. 4. Dissect and separate fibrous tissue and adhesion around the diverticulum. Use an Allis forceps or Babcock forceps to clamp the bottom of the diverticulum as traction to facilitate anatomy of the diverticulum. 5. Separate the esophageal muscle layer at the beginning of the diverticulum and carefully confirm the mucosal bulge at the neck of the diverticulum. The muscles of the place were picked up with a right angle pliers and cut with an electric knife. The incision was extended downward and backward to about 2 cm behind the clavicle, and extended upward to the upper corner of the thyroid cartilage, with a total length of about 7 to 10 cm. 6. If the size of the diverticulum is 1.5 to 2 cm or less, it is generally not necessary to remove it. If the diverticulum is large, the neck of the diverticulum can be sutured with an automatic suturing device, and then the diverticulum can be removed. 7. Rinse the wound Insert the stomach tube into the esophageal cavity of the neck for inflation test, and carefully check the leakage of the proximal margin of the diverticulum. If gas is found to escape, the suture is repaired with a thin thread at the mucosal tear, and the gastric tube is inserted into the stomach for postoperative gastrointestinal decompression. 8. Incision built-in drainage strips. 9. Suture the incision layer by layer. complication This procedure has fewer complications, no surgical death, and satisfactory surgical results. Most patients with postoperative dysphagia are relieved and can enter the general diet. The less common postoperative complications are: 1. Saliva. 2. Vocal cord (left) paralysis. 3. Occasionally mild swallowing is not smooth. 4. Individual patients did not improve after surgery due to difficult symptoms.