Transthoracic esophagectomy, right 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 Right chest esophagectomy, right neck esophagogastric anastomosis for: 1. Esophageal cancer is located above the level of tracheal ridge. 2. Middle esophageal cancer is expected to be removed by a sufficient length. Preoperative preparation Intratracheal intubation was general anesthesia, the patient was placed 45° on the left side of the shoulder, and the head was biased to the left, exposing the right neck, right chest and abdomen. Surgical procedure 1. Incision right neck, right chest anterior lateral and upper abdomen or middle left upper abdomen median incision. 2. The operation can be performed in the cervical and thoracic group and the abdomen group, and one group can complete the operation. The cervical and thoracic group was first made into the right anterolateral thoracic incision, and the chest was inserted into the chest through the fourth intercostal space The tumor was probed and confirmed to be resectable (at this time, the abdominal surgery group started surgery), and the azygous vein was first ligated to facilitate the exposure of the esophagus. The esophagus was dissected and the mediastinal lymph nodes were removed. The esophagus was cut above the esophageal hiatus. The upper and lower ends were temporarily ligated and covered with a rubber sleeve. The esophageal hiatus is enlarged, and the lower esophagus is sent to the abdominal cavity through the hiatus, and the chest operation is suspended. 3. Replace the gloves in the neck and chest group for the anterior incision of the right neck sternocleidomastoid, and the operation is the same as the left neck. Free the cervical esophagus and lead the esophagus along with the tumor, free to a sufficient length, clamp with a right angle pliers, remove the cut esophagus, expand the thoracic entrance, so that it can pass the 3 fingers to facilitate the stomach from the chest Lead out. 4. Abdominal group through the middle of the upper abdomen or the upper right inferior midline incision into the abdomen, the stomach is seen in the description of "thoracic esophageal anastomosis", the stomach is free and sutured to close the cardia, the stomach through the esophageal hiatus into the right chest and up Lift the stomach to the neck and the esophagus. 5. Right neck esophagogastric anastomosis, the same way as "left neck esophagogastric anastomosis". After the anastomosis is completed, the rubber drainage is placed and the neck wound is sutured. 6. Thoracic and abdominal cavity completely stop bleeding, place closed thoracic drainage, and suture the chest and abdominal cavity layer by layer.

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