Esophagectomy

Esophagectomy is a common surgical method for the treatment of esophageal tumors and esophageal long scar stenosis and esophageal duplication. If esophageal resection is performed in patients with esophageal cancer, if there is no obvious lymph node metastasis and distant metastasis around the lesion, and the malignancy of the cancer is not high, good postoperative results can be obtained, and long-term survival can be achieved with good prognosis. . Conversely, if the tumor is highly malignant and has local or distant metastases, the prognosis is poor. Other benign diseases have a good prognosis after esophagectomy. Treatment of diseases: esophageal diverticulum esophageal cancer Indication Esophageal cancer, benign esophageal stricture, esophageal sclerosis, traumatic esophageal perforation, esophageal diverticulum, and esophageal duplication. Among them, esophageal cancer is the most common. Contraindications 1. Patients with poor cardiopulmonary function or severe renal disease who cannot undergo major surgery. 2, those with bleeding disorders (such as hemophilia or aplastic anemia). 3. The tumor has seriously invaded adjacent organs or large blood vessels and cannot be separated. 4. Those who are already in a state of severe malnutrition. Preoperative preparation 1 Correct the water and electrolyte disorders. 2 adequately treat pulmonary complications until the acute phase subsides. 3 Before the operation, 1 day before the operation and on the morning of the operation, a stomach tube without a side hole was placed to clean the food, debris and secretions in the esophagus, and the stomach tube was retained to reduce the risk of aspiration during anesthesia induction. 6 Antibiotics were given 1 to 2 days before surgery. Surgical procedure 1. Choose a position and make an incision. 2. Pull the lungs forward and inward, reveal the posterior mediastinum and carefully explore. 3. Cut the diaphragm. 4. Separate the esophagus. 5. Separate the stomach. 6, cut off the door. 7. Adjust the position of the esophagus. 8, esophagogastric anastomosis: according to the location of the lesion, size and the nature of the resection (radical or palliative) to determine the site of anastomosis. 9, close the chest. complication Postoperative food reflux symptoms, anastomotic stenosis occurred in the long-term after surgery. Anastomotic fistula is a serious complication after esophageal surgery and is the main cause of death. Most cases occur after 3 to 5 days after surgery, and some can occur after 10 days after surgery. The earlier the occurrence, the worse the prognosis. Generally, the body temperature and pulse rate gradually decrease after 3 to 4 days after surgery, and the physical strength gradually recovers. However, if the body temperature rises again after 4-7 days after surgery, the pulse rate increases rapidly, and chest pain, shortness of breath, and fatigue are observed. Physical examination and X-ray examination show more effusion or pneumothorax in the chest. The possibility of anastomotic leakage should be considered. Oral a little blue or gentian violet, and then chest puncture. If you take out a blue or purple liquid, you can confirm the diagnosis. At this time, closed drainage should be performed as early as possible, and high-dose antibiotics should be used to control infection, blood transfusion, infusion and other systemic supportive treatment. At the same time stop oral, change the stomach tube or jejunum for nutrition. The small mouth may heal itself. In the case of severe infection, early repair of the mouth is difficult to succeed. After a certain period of observation, if the mouth is not cured, the esophagus can be externally placed. After the patient's general condition is improved, the sternal or colonic esophagus surgery can be considered.