Resection of lower esophagus and cardia cancer

Stage 1.0, stage I, stage II esophageal chest and upper thoracic carcinoma, lower thoracic cancer can be relaxed to stage III, more limited to the cardia cancer, the general condition is good, no surgical contraindications. 2. Esophageal cancer recurrence after radiotherapy, the extent of lesions is not large, no distant metastasis, and good general condition. 3. High esophageal obstruction, no distant metastasis, and general conditions, should actively seek surgical exploration. Unresectable, feasible bypass surgery, supplemented by radiotherapy, chemotherapy and immunotherapy. Treatment of diseases: esophageal cancer, other malignant tumors Indication Stage 1.0, stage I, stage II esophageal chest and upper thoracic carcinoma, lower thoracic cancer can be relaxed to stage III; more limited cardia cancer, general condition, no surgical contraindications. 2. Esophageal cancer recurrence after radiotherapy, the extent of lesions is not large, no distant metastasis, and good general condition. 3. High esophageal obstruction, no distant metastasis, and general conditions, should actively seek surgical exploration. Unresectable, feasible bypass surgery, supplemented by radiotherapy, chemotherapy and immunotherapy. Contraindications The patient is too old and should be filled with poor general condition. Preoperative preparation 1. Patients with high esophageal obstruction, wash the esophagus 3 days before surgery. 2. Oral esophageal anti-inflammatory drugs are taken after the hospital. 3. Strengthen nutrition and correct water and electrolyte disorders. 4. Colon transplants are prepared for colon cancer. Surgical procedure 1. Incision: 7th intercostal space or ribbed incision in the posterior aspect of the left chest. 2. The left lower lobe is retracted forward and upward, and the mediastinal pleura is cut longitudinally between the pericardium and the thoracic aorta. 3. Use your fingers to pull out the lower part of the esophagus and pull it with a gauze strip. Should try to avoid damage to the contralateral mediastinum pleura. 4. Explore the lesion. Pay attention to the location and size of the tumor; whether there is infiltration in the front, and whether there is lymph node metastasis in the mediastinum. Once the tumor has been resectable, the esophageal detachment should be suspended. 5. Incision of the diaphragm between the left lobe of the liver and the spleen. Stop bleeding when cutting, and avoid damage to the phrenic nerve. 6. Exploring the presence or absence of metastasis of the abdominal organs, paying special attention to the liver, spleen and lymph nodes around the left gastric artery. 7. Open the gastric colon ligament, clamp, cut, and ligature the left gastric artery and short gastric artery. 8. Free stomach small bends. The left gastric artery was separated from the upper edge of the pancreas, cut off after clamping, and the proximal end was ligated and sutured. The surrounding lymph nodes should be cleared. When handling the above gastric vessels, always pay attention to avoid damage to the edge of the blood vessels on the curved side of the stomach. 9. Cut the stomach 5 cm away from the edge of the tumor. The cut surface is oblique, and the stomach is mostly curved. 10. The distal end of the stomach is sutured in a continuous (or intermittent) full-thickness layer, and then the muscle layer is sutured. 11. Esophagogastric end-to-side anastomosis: the esophagus near the large curved side of the anterior wall of the fundus and 5 cm away from the upper edge of the tumor, as an anastomosis plane. In the first row, the muscle wall of the posterior wall of the esophagus and the anterior wall of the fundus were sutured with a thin wire, and the needle spacing was 0.3 cm. All the seams are finished and then knotted. 12. At a distance of 1 cm from the suture line, the muscle wall of the stomach wall was cut corresponding to the width of the esophagus, and the submucosal blood vessels were sutured. Cut the mucosa and drain the stomach. The muscle layer of the posterior wall of the esophagus was cut at the same margin, and the mucosa should be kept 0.3cm. 13. The second row is interrupted by full-layer suture. Generally 8 to 10 needles, the needle spacing is 0.3 cm, and the margin is 0.5 cm. The two edges of the mucosa are required to be neatly aligned. The stomach tube is sent to the stomach through the anastomosis, reaching the pyloric area. 14. The third row of sutures are cut off from the ends of the anastomosis to the middle side, and the anterior wall of the esophagus is interrupted and the whole layer is inverted or everted. 15. Finally suture the esophageal muscle layer and the gastric muscle layer. Generally 5 to 7 needles, lcm from the upper suture. The anastomosis forms a set of stacked prosthetic valves that reduce post-operative food reflux. 16. Esophagogastric end-to-end anastomosis: due to the great curvature of the great curvature of the stomach, after the stomach is broken, the large curved lateral incision of the distal end of the stomach is retained for 3 to 4 cm without suturing, and it is used as an anastomosis for the stomach. After the small curved side is sutured, the residual stomach is naturally tubular. The esophagus is anastomosed to the end of the large curved line of the stomach, and the method is the same as that of the esophagus. 17. The thick silk sutures the diaphragm, and the incision margin of the stomach wall and the diaphragm is fixed with a thin wire suture, and the needle spacing is lcm. Care should be taken not to damage or compress the vascular arch of the stomach wall. 18. Rinse the chest, place a closed drainage tube, place antibiotics, and suture the incision. complication Esophageal reflux.