upper esophagus cancer resection

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, 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 in the elderly 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. 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. The 6th ribbed or intercostal incision on the posterolateral side of the right chest. 2. The mediastinal pleura was cut longitudinally from the inside of the azygous vein, and a segment of the esophagus was removed and the traction was taken. After the tumor was resected, the azygous arch was separated, and the ligation was performed after ligation and suture. 3. Free thoracic esophagus, up to the top of the pleura, and to the cardia. The tissues adjacent to the esophagus should be ligated. Avoid damage to the thoracic duct. Subcarinal and paraesophageal lymph nodes were removed. 4. Open the esophageal hiatus by 3cm and suture to stop bleeding. Surround the cardia and cut all the peritoneum. The cardia was cut, the two layers of the distal end were sutured closed, and a rubber sleeve was ligated at the proximal end. The ends are connected by a filament. 5. Close the chest. The method is the same as before. 6. Change the lying position. The head is biased to the right. The median incision of the upper abdomen enters the abdominal cavity. The stomach is free to the pylorus (the method is the same as before). 7. The stomach body is stretched upwards, and the 3-needle traction line is sutured at a distance of 1 cm from the spleen and stomach ligament at the posterior wall of the highest point of the stomach. Cut the cardia suture and connect the esophageal ligature with the fundus traction line. 8. Left neck sternocleidomastoid incision (method with esophageal neck diverticulum surgery). The esophagus is raised behind the trachea. Do not damage the left recurrent laryngeal nerve. 9. Pull out the esophagus and traction line from the neck upwards, and at the same time push the stomach through the enlarged hiatus of the esophageal tube and push it upward through the esophageal bed. Make a neck incision on the fundus. During the push of the stomach, the stomach should be prevented from twisting or tearing the fundus tissue. 10. In the neck incision, the esophagus is anastomosed to the end of the stomach. The method is the same as before. After the anastomosis is completed, the anterior wall of the stomach is fixed to the tissue around the neck, and 2 to 3 needles are sewn. 11. Suture the abdominal incision. 12. After rinsing the neck incision, place one rubber drainage strip and suture the neck incision. 13. The method of passing the left chest can also be used. The fundus is lifted to the left neck incision through the left thoracic cavity in the anterior aspect of the aortic arch, and can also be incision through the esophageal bed. 14. Sometimes it is necessary to transplant a segment of the colon and perform an esophagus-colon anastomosis in the neck. Through the mid-abdominal incision, the gastric ligament is incision, the colon is lifted, the distribution of mesenteric vessels is observed, the colon segment is selected, and the length of the desired colon is accurately measured. In principle, it is required to be short. The esophagus is presented through the left neck incision. The sternal posterior sternal tunnel was bluntly removed, and the pleural membranes on the left and right mediastinum were pushed open, and the width was 5 cm, so that the upper and lower sides were penetrated. The guide strip is sent from the neck incision through the tunnel, and the colon is guided to the neck incision in the posterior gastric ligament incision and the posterior sternal tunnel. The esophageal colon end-to-end anastomosis (the esophageal burn is performed on the esophageal colon side). End anastomosis), the lower end of the colon - gastric end side anastomosis. In the intra-abdominal colon, colon-colon end-to-end anastomosis is performed. 15. If the tumor cannot be resected, the stomach is freed, the stomach is lifted to the thoracic cavity, and the aortic arch is descended to the lateral side of the esophagus. If the tumor is located at a higher position, the anastomotic plane is selected above the aortic arch.

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