Right chest – upper abdomen middle – neck incision (Akiyama surgery). Mckeown described in 1985, this surgical procedure in the Ivor Lewis on the basis of an addition of a neck incision, avoiding the intrathoracic anastomotic thin danger.
About esophageal cancer surgery (1) indications. For esophageal chest, the middle radical cancer surgery.
Introduction to esophageal cancer surgery (2) advantages. All right chest fully exposed by the thoracic esophagus, in particular, is suspected to invade and trachea, right main bronchus, azygos vein arch and aortic arch of esophageal cancer . The three-field lymph node dissection incision to facilitate, to maximize tumor resection, to avoid cervical esophageal cancer metastasis undetected under; the prognosis of cervical anastomotic lean far better than the intrathoracic anastomotic thin.
About esophageal cancer surgery (3) shortcomings. Incision and more trauma, although the neck chest and abdomen can be divided into two groups operate simultaneously, but the relatively long operative time, heart, lung, liver, kidney function is poor and frail elderly patients, postoperative pneumonia and acute complications such as respiratory distress syndrome opportunities.
About esophageal cancer surgery (4) surgical approach. Patients usually first placed in the left side of 45. Supine, the right anterior lateral incision under the free from the esophagus, the tumor to the chest top, and clear the chest lymph nodes (Lewis operation).
Free esophagus, the abdominal group surgeon free stomach abdominal incision, and abdominal lymph nodes removed. Neck group group of physicians and abdominal surgeon and started free neck esophagus. Prominent in the esophagus because the cervical trachea to the left edge of the esophagus by the left than the right of free easy, therefore, the left sternocleidomastoid esophageal surgery before the incision is the most commonly used incision in the neck, but after the incision is difficult to conduct a thorough neck dissection. In addition, transverse cervical incision, the thyroid isthmus before the neck incision, neck incision, the neck "U"-shaped incision, neck incision in the esophagus of a sternum surgery applied from time to time.
The left sternocleidomastoid muscle before the incision operation, starting from the sternal notch, sternocleidomastoid muscle anterior to the mastoid process along the direction of skin incision 8-10cm, cut off the platysma and cervical fascia, if neck cross-vein and incision should be ligated and cut off. The two incisions were at the edge of a surgical towel to protect home. Hyoid muscle off the shoulder of liver, thyroid vein and the inferior thyroid artery, through the jugular vein inside the beam, the dissociation from the side of the esophagus, as in the esophagus and the spine of a loose connective tissue between the gap, so in the esophagus with gauze after swabs or fingers easier dissociation. Free cervical esophagus, it is necessary to protect the left and right recurrent laryngeal nerve, left recurrent laryngeal nerve to go for a line in the esophageal tracheal groove, and more difficult to damage; and the right subclavian artery from the right recurrent laryngeal nerve reverse up inward oblique sometimes difficult to locate because of the location of the mutation, if the direction of dissociation to be widely extended to the mediastinum, often easy to damage the nerve.
At this point the nerve should be dissected to avoid injury. Free cervical esophagus, it will pull the thoracic esophagus by the neck. Cervical lymph node dissection, and then led outside the sternocleidomastoid muscle, within gently pull the trachea, lymph node dissection and tracheal supraclavicular lymph nodes. Or along the mediastinal esophageal bed after sternum stomach (colon) lead to the neck, a stomach and esophageal (colon) neck anastomosis. After a successful match, flush cut, set rubber tube drainage, suture deep fascia, platysma and skin. Abdominal group of physicians in the neck of a group of physicians gastric esophageal anastomosis neck, chest and abdomen were closed layer by layer.