Introduction of esophageal incision

By | March 22, 2012

Esophageal incision described (Lewis operation) is introduced in 1946, Lewis operative, also known as Ivor-Lewis surgery. Surgical incision through the right anterolateral or posterolateral incision and the abdominal incision. Esophageal resection according to tumor location and histological type. Lewis said: Because cancer is a multi-center, so they requested removal of the whole esophagus, stomach and chest for a top-esophageal anastomosis; but mainly in the submucosal invasive adenocarcinoma, and called for removal of more than 5cm away from the tumor proximal and distal esophagus and esophageal normal surrounding tissue. During the operation to clear the upper mediastinal region lymph nodes, subcarinal lymph nodes, paraesophageal lymph nodes, paratracheal lymph nodes, and gastric cardia and lymph nodes around the celiac lymph nodes.
Esophageal incision of (1) indications. For chest, middle and lower esophageal surgical resection, especially for the aortic arch in the plane, or while in the aortic arch, but mainly in the right side of the tumor lesion; esophageal cancer associated with obesity in the chest section; have done abdominal surgery, or stomach and estimates of duodenal ulcer patients who have severe abdominal adhesions.
Esophageal incision Introduction (2) advantages. Because ligation of the azygos vein arch, so that the mediastinum, trachea and thoracic esophagus fully reveal all, easy to free the tumor, lymph node dissection and anastomosis; obese patients retinal hypertrophy, history of abdominal surgery and abdominal gastroduodenal ulcer patients and more a heavier adhesion of these patients free of the incision over the stomach by the brain has obvious advantages.
Esophageal incision described (3) shortcomings. Approach to transform the operating table to shake the position, satisfactory exposure of patients with abdominal obesity; difficult to fully reveal the thoracic aorta injury than a single large incision in the chest.
Esophageal incision described (4) surgical approach. Left 60. Reclining position, the right thoracic or right posterolateral incision anterolateral incision, 5 or 6 ribs rib into the upper edge of the chest, whether resected esophageal probe. If removed, then move forward with a large gauze under the lung retractor, cut the mediastinal pleura, azygos vein free and cut off after the ligation proximal and distal. Around the esophagus and do along the sharp separation of the tumor, one by one vessel ligation, removing the trachea, bronchus, subcarinal, paraesophageal, upper mediastinal lymph nodes in each group.
Esophagus and cancer free after breast esophagus will use two large rectangular clamp jaws, and cut off. People with a rubber condom after esophageal ligation on the stump. After disinfection with alcohol under the stump sutured abdominal cavity by pushing people esophageal hiatus. Shake the operating table to the right patient, the abdominal incision, on up to xiphoid, lower than umbilical 2-3cm, layered cut the abdominal wall into the abdominal cavity. Abdominal exploration, pay attention to the liver, spleen door, pancreas, peritoneum, etc. metastasis. Then cut off the triangular ligament of liver, pull up the left lobe of the liver, stomach, greater curvature of free, cutting short gastric arteries. Free big bend, it will pull down the stomach, the stomach exposed to a small bend, cut along the left gastric artery lymph nodes around it clean. In the cardia resection of residual esophagus, cardia and do purse suture plunged into embedded Layer 2. Approach with blunt or sharp expansion of esophageal hiatus, so that it can accommodate four cross fingers. The hole will be pulled free of the stomach into the thoracic cavity. According to the location of the tumor, a gastric esophageal chest or thoracic anastomosis top.


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