Extended cervical esophagotomy

Diverticulosis can occur in the pharyngeal esophageal diverticulum, and the incidence is unclear. If the pharyngeal esophageal cancer is confined to the diverticulum sac, as long as the diverticulum is completely removed, the purpose of the cure can be achieved; if the cancer occurs in the opening of the diverticulum, esophagectomy should be performed, and it is difficult to achieve radical cure by simply removing the diverticulum. According to statistics from Nanosn (1976), 65% of patients with pharyngeal esophageal cancer after death under simple diverticulum died within 2 years. If the pharyngeal esophageal diverticulum with pharyngeal muscle dysfunction or recurrence after pharyngeal esophageal diverticulectomy, extended cervical esophageal myotomy can be used. Treatment of diseases: esophageal diverticulum esophageal diverticulum Indication 1 pharyngeal esophageal diverticulum combined with cycloparyngeal muscle dysfunction (dysphagia). 2 recurrence after pharyngeal esophageal diverticulectomy. 3 other causes of swallowing dysfunction, such as cerebral vascular accidents after dysphagia, symptomatic thoracic esophageal fistula or polymyositis. Preoperative preparation 1. Esophageal barium meal or esophagoscopy examination of lesions and size. 2. Oral esophageal anti-inflammatory drugs. 3. Enter the fluid diet 1 to 2 days before surgery. Place the stomach tube before surgery. Surgical procedure Endotracheal intubation, intravenous anesthesia. After anesthesia, the esophagus can be examined with a hard esophagus to exclude inflammatory diseases of the esophageal fistula or esophagus, and the capacity of the pharyngeal esophageal diverticulum can be estimated. The patient is placed in a supine position with a slightly elevated shoulder for the neck to stretch. The patient's occipital pad has a head and the head is biased to the right. 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 layer by layer; 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. 3 continue to separate the cervical fascia layer to the anterior fascia. In order to facilitate the dissection and exposure of the cervical esophagus and diverticulum, a probe can be inserted from the nasal cavity to the cervical esophagus. 4 Anatomical separation of 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. Then, use a right angle clamp to pick up the muscles at that place, and cut it with an electric knife. The incision is extended downward and backward to the collarbone about 2 cm, and extended upward to the upper corner of the thyroid cartilage, with a total length of 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 gastric 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, it is sutured with a thin wire at the tear of the mucosa, and the stomach tube is inserted into the stomach for postoperative gastrointestinal decompression. complication Surgical complications include diverticulum resection, fistula formation, and injury of the recurrent laryngeal nerve. Postoperative fistula formation occurs mostly around the first week after surgery, and saliva secretion occurs at the wound, which can last for a few weeks or months and usually heal itself. Temporary injury to the recurrent laryngeal nerve can be restored, and permanent damage is rare. Excessive mucosal resection can occur esophageal stenosis, dilatation is effective, and expansion failure requires secondary surgery to correct stenosis.