Transthoracic esophagectomy, left cervical esophagogastric anastomosis

At present, the use of esophageal cancer for esophagogastric neck anastomosis is gradually increasing. The neck anastomosis not only increases the length of esophageal resection, but also reduces the chance of residual cancer in the esophageal end of the tumor, and it is easy to handle even if an anastomotic fistula occurs, and it is not life-threatening. Common neck anastomosis methods are: 1 left chest esophagectomy, left neck esophagogastric anastomosis; 2 right chest esophagectomy, right neck esophagogastric anastomosis; 3 non-open thoracic esophagectomy, esophagogastric neck anastomosis ; 4 through the neck, sternotomy and abdominal path esophagogastric anastomosis; 5Kirschner surgery. Treating diseases: esophageal cancer Indication Left chest esophagectomy, left neck esophagogastric anastomosis for: 1. The cervical and upper thoracic esophageal cancer. 2. The middle thoracic esophageal cancer is expected to be resected for a sufficient length to avoid residual esophageal margin 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 neck 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 Anesthesia and position Intratracheal intubation was performed under general anesthesia, and the patient was placed in the right lateral position with the head slightly reclined. Disintegrate the left upper limb and place it on the chest arm to move it down when the left neck incision is revealed. Surgical procedure Incision Left posterior thoracic incision and left sternal sternocleidomastoid incision. If the tumor is located in the cervical esophagus above the thoracic entrance, a left neck incision can be performed. 2. First through the left chest explorer, open the mediastinum pleura to explore the tumor If the tumor is located behind the aortic arch, if the separation is difficult, the posterior part of the aortic arch and the descending aorta can be freed, and gently pulled forward with a cloth strap to expose the esophagus in the posterior segment of the aortic arch, which is not only beneficial for the separation and resection of the tumor. Azygous or thoracic duct injuries are also easy to handle. After the tumor and the thoracic esophagus are free, the left diaphragm is cut and the stomach is free. Because the stomach is lifted to the neck, the stomach should be completely freed. If necessary, the pylorus and duodenum posterior peritoneum can be properly released. In order to prevent postoperative gastric emptying, it is feasible to form a pyloric or pyloric muscle. The esophagus was cut off at the Tuen Mun section. The two stumps were iodine-free and ethanol-swept. The esophageal end was inserted into the rubber sheath and the suture was closed. The highest position of the fundus is sutured with 2 to 3 needles. It is best to suture with different color threads to make the anterior-posterior direction of the stomach to avoid stomach twist when pulled out of the chest. The esophageal bed, the abdominal cavity completely stopped bleeding, and suspended intrathoracic operation. 3. Left neck incision The thyroid cartilage plane is on, down to the upper edge of the sternal notch. Cut the skin and platysma, pull the sternocleidomastoid muscles back and forth, separate and cut off the scapular and sternal musculoskeletal muscles, pull the thyroid gland and trachea to the medial side, and pull the common carotid artery outward, revealing and The cervical esophagus is released, the left hand passes through the chest, and the right hand meets through the neck, and the esophagus is released and taken out from the neck. The esophagus is detached upwards to a sufficient length to enlarge the thoracic entrance to accommodate a width of 3 fingers. 4. Pull the bottom of the stomach to the neck incision The tissue clamp can be used to clamp the traction. At least 5 cm above the tumor, the esophagus is cut with a large right angle clamp, and the esophagus removed portion is removed for esophagogastric anastomosis. At 1.5cm from the esophageal stump, the posterior esophageal muscle layer and the gastric musculoskeletal layer were sutured horizontally and sutured 3 to 4 needles, and the stomach was separated from the muscle layer by 1.5 cm for a 2.5 to 3 cm transverse incision. The intermittent full-thickness sutured the esophagus and stomach. Rear wall and front wall. The anterior wall muscle layer is sutured with 3 to 4 needles. If the stomach is not loose enough, the anterior wall may not be embedded in the sarcolemma. The front wall of the stomach and the entrance to the thorax are sewed 2 to 3 needles to separate the neck incision from the chest cavity. The neck incision is placed with rubber drainage, and the muscle layer and skin are loosely sutured.