Surgical treatment of esophageal cancer in principle, should strive for complete removal of most of the esophagus.
1.Preoperative preparation
Suitable for surgical treatment of patients, according to the general condition of patients, tumor growth and location, tumor length, tumor imaging, tumor biological characteristics and other factors do a good job preoperative preparation.To have chronic diseases, nutrition and electrolyte imbalance and correct to active treatment, and to do according to respiratory, intestinal and other preparations.Adequate preoperative preparation to be effective in reducing postoperative complications and death rate is an important part of successful operation.
2.Surgical
Upper thoracic esophageal cancer by Youxiong general approach, in the lower thoracic esophageal cancer through left into the road.
(1)The right thoracic esophageal cancer resection in the upper thoracic esophagus a bit more on the right chest, while the aorta and descending aorta is located on the left, the right thoracic aortic occlusion-free approach can be significantly better on the gel thoracic esophagus and the esophageal wide excision, and in doing chest or neck esophagogastrostomy.
(2)esophageal cancer through left chest into the road, good exposure in the lower esophagus, and aorta under direct vision proved the tumor, the left bronchus, hilar, pulmonary vein and other relations, according to pathological conditions to the stomach, esophagus on the bow, bow down or cervical anastomosis.Left chest surgical approach is relatively simple, less invasive, fewer complications, using the most.
(3)on the neck and esophageal cancer esophageal cancer, especially breast cancer in the thoracic inlet can be pulled off the esophagus without thoracotomy with resection of thoracic esophagus, but also can be combined median sternotomy incision and upper abdominal incision and removal of the upper esophagus free stomach.
(4)left thoracoabdominal incision esophagectomy of esophageal cancer involving the yellow door or abdominal esophageal cancer, the use of this method to remove sufficient length of esophagus, and abdominal lymph nodes can be removed.
3.Postoperative complications
Such as esophageal cancer after surgical treatment of complications, should be timely, appropriate treatment.Common complications are as follows:
(1)anastomotic thin is the most common postoperative complications, mortality is higher complication rate.Main reasons causing anastomotic thin perforated gastric necrosis, esophageal wall through holes, improper suture, postoperative treatment inappropriate.Therefore, surgical indication to strictly control, fine to operate, to the broad-spectrum prophylactic antibiotics and so on.If anastomotic thin, to do an effective closed thoracic drainage, supportive care, high fasting and intravenous nutrition, if necessary, make thin and jejunum do open heart surgery two times.
(2)simple axillary thoracotomy in a timely manner to prevent pollution and pleural pleural puncture plot than tuck version of the chest to prevent important ways.The treatment of simple clothing optional closed chest drainage or puncture dirty, and, and local and systemic use of effective antibiotics.
(3),pulmonary complications, pulmonary complications to pneumonia, atelectasis and pulmonary dysfunction more common.Preoperative respiratory preparation, respiratory tract and cleared up after lung recruitment, encourage, assist patients to cough sputum and the application of appropriate antibiotics is an important measure to prevent pulmonary complications.
(4)breast milk honest conservative treatment first, if conservative treatment fails to promptly treated by surgery.
(5),anastomotic stenosis should first identify whether the result of tumor recurrence.If it is not due to tumor recurrence, viable dilation or laser treatment.If tumor recurrence, the patient should be based on comprehensive treatment of the actual situation.
Surgical treatment of esophageal cancer,(6)Other Other complications of esophageal cancer after breast main store, traumatic break grams, gastric volvulus, recurrent laryngeal nerve injury.