After esophageal resection lateral chest incision

By | March 23, 2012

After esophageal resection lateral left chest incision, which is esophageal or cardiac carcinoma, gastric esophageal ideal graft incision, the surgeon is most commonly used incision.
Since the position of the lower esophagus bias left front, left chest incision on the lower esophageal and gastric reveal the best and easy surgical operation. Through a left thoracotomy incision chest muscle, said after the stomach free of any part of the chest and esophageal anastomosis. Resection of upper esophageal carcinoma and may also, left chest incision, the stomach to the neck and esophageal raised. Ligaments in the stomach within the short gastric artery, left gastroepiploic artery ligation splitting off, chest muscles clamp angle cut off, left gastric artery can be better revealed. Therefore, this incision on the left gastric artery and lymph node removal treatment than other incisions convenience. For the esophageal or gastric cardia, cancer can not be removed through the probe, according to the lesion, aortic arch or the arch of esophageal anastomosis for a gastric bypass, also the most convenient left chest incision.
Esophageal cancer after resection of the lateral chest incision, the aortic arch in the middle esophagus and descending aorta with adhesive or separation process, such as the aorta or aortic arch injuries encountered in processing, than the right chest, left chest incision to facilitate operation . Left chest incision only inadequate, is a plane up and down the middle of the aortic arch revealed maneuver esophageal cancer, especially cancer and azygos vein after a left thoracotomy incision lateral adhesion, need to cut off the azygos vein ligated, the left chest incision operation not convenient right chest incision. Left thoracotomy approach currently used in two ways.
rib resection bed by the rib into the chest method. Resection of esophageal cancer to be done to the aortic arch or neck esophagogastrostomy who cut along the rib 6, the former from the costal arch around the shoulder and ends up lower corner of the liver after 4 ribs. Cut chest wall muscle, ribs separated the periosteum, the total removal of 6 ribs, then cut rib periosteum and the parietal pleura into the pleural cavity. Cardia resection of a gastric esophagus to be done under the agreement by the aortic arch, as indicated in Law 7 ribs into the chest removed. Some patients were on top of the esophagus of a thoracic aortic arch anastomosis or the location of the higher case, also advocated the removal of the rear of 5 short ribs, or cut off the 7th costal cartilage in order to expand the incision to get a good chest and abdomen revealed the top . The thoracotomy approach is not only time-longer, and more blood loss, postoperative ossification of the rib periosteum and the incision scar formation of epilepsy, patients often have longer incision pain and discomfort.
from the intercostal thoracic law. 6 along the intercostal incision line drawn with gentian violet solution, the former from the costal arch around the shoulder and under the angle of the liver, the liver and the spine between the shoulder ends up after the first 4 ribs. Subcutaneous skin incision, the chest wall muscle up and down with a thick silk suture the cut off, or with a large curved clamp beam clamp off after the ligation. Doing cutting edge of spinal muscle rib 6, 6 cut into the intercostal muscle and parietal pleura chest, intercostal vessels and intercostal nerve clamp cut ligation. Esophageal resection of gastric cardia aortic arch of a person under the agreement, as indicated in Law from the intercostal thoracic 7. To be done on individual cases or chest upper chest revealed the top match is not satisfied until the lower esophagus and the stomach completely free after the free time of esophageal aortic arch after the first 5 ribs can be cut back. The thoracotomy approach, not only little blood loss, and shortened the time of thoracotomy, usually 5-10min to successfully enter the thoracic cavity.
After esophageal resection lateral left chest incision, using lateral chest incision after thoracotomy, the patients take the right lateral position, in the right chest underarm cushion, with a thicker front and rear with a smaller sandbags volume fixed. Straight fixed right upper limb, left upper limb flexion naturally put on the right, do not do suspension, right leg straight, left leg flexion, the left knee of a thick cotton pad pillow, patients with hip fixed on the operating table with a fixed. If a pre-esophageal anastomosis neck line, position above, should also be prepared to skin the neck and chest, left upper limb after disinfection, wrapped with sterile towels and placed inside the surgical field.

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