Esophageal Cancer

By | March 21, 2012

Note esophageal resection
1. esophageal smooth successful resection of the tumor with surgery directly related to whether the removal of the judge. Mistakenly removed the tumor can be removed as not to give up surgery, or the removal of the tumor can not be regarded as surgery to remove the force, we can not save the patient's life, but increased the burden on the patient.
2. Anastomosis above the free section of the esophagus not be too long, generally within 5cm, the muscle should be complete and not torn. Not damage the stomach, small and large curved vascular arcades, lack of blood supply in order to avoid anastomotic healing. Esophagus and stomach consistent with the best use of sets or embedded into the method, each suture needle when the inner layer to both sides of the film on the rope to be stitched, and with interrupted sutures, so as to avoid anastomotic stenosis. Layers of sutures must not be too dense, too tight, careful not to tear the esophagus, which are important preventive measures for anastomotic leakage.
3. Separation of the posterior wall of the esophagus, the mediastinal tissue should be cut ligation; pay attention not to damage the thoracic duct, such as the injury should be the ligation. Such as rupture of the contralateral mediastinal pleura, shall promptly repair; not fix, the customs should be placed opposite the chest closed thoracic drainage tube.
4. Separation of sharp esophageal operation as far as possible, and make the necessary ligation of bleeding, the tumor will be removed along with surrounding lymph nodes. Finger blunt dissection is not only difficult to completely remove the tumor tissue, and easy to tear the tumor and surrounding organs.
5. In the aortic arch after esophageal anastomosis, suture the diaphragm should be careful not to narrow the chest mentioned in the body of stomach; the diaphragm and the needle between the stomach is not too sparse, part of the costophrenic angles should be tight seam, to avoid diaphragmatic hernia.
6. The removal of tumor, stomach and colon can not use stump anastomosis with the esophagus, jejunum can be used instead. Microsurgical operation, will be a free jejunal graft for anastomosis to deal with esophageal defect, or transplantation of jejunum with vascular pedicle, and the upper mesenteric artery and vein anastomosis with the adjacent parts, to enhance its the end of the blood supply.
After resection of esophageal cancer treatment
1. With the other treatment after thoracotomy.
2. Back to the ward after the tube connections will continue to attract, every 3 to 4 hours with a small amount of warm water to keep them open. Generally continue to attract 36 to 48 hours until the patient began to recover gastrointestinal function, you can stop. First clamped tube 4 to 6 hours of observation, without gas, removed forthwith.
3. Fasting period, the first 1,2 days, the daily infusion of about 2,500 ml, potassium 3g, if necessary, blood transfusion or albumin. After 48 hours of maintenance to operate slowly began to trickle nutrient 1,000 ~ 1,500 ml, less than in part by the intravenous supplement; if no adverse reaction, 4 can give enough after the date of about 3,000 ml. 1 to 2 days starting nutrient solution can only use glucose and vitamins, can be gradually changed after the soy milk, rice soup and milk.
4. Since the 5th day of oral sugar, rice soup, milk and milk per hour, 60ml, after increasing day by day, until the hour 200ml. 9 in future into the semi-liquid diet, after 2 weeks you can start into smaller meals of ordinary food. If agreement were less satisfied or have concerns, should be delayed oral date.
5. Anastomotic leakage is a serious complication after esophageal surgery, but also the leading cause of death. Fistulas occurred in 3 to 5 days after surgery, the individual can occur within 10 days after the earlier occurrence, the worse the prognosis. Usually after 3 to 4 at body temperature, pulse rate and more gradual decline in strength is gradually restored. However, if the 4 to 7 after a sudden rise in body temperature again, faster pulse rate and chest pain, shortness of breath, fatigue, physical examination and chest X-ray examination see more fluid or water pneumothorax should consider the possibility of anastomotic leakage, can be oral a little blue or gentian violet, further thoracentesis. If out of the blue or purple liquids can be confirmed. At this point, should try to be closed drainage, large doses of antibiotics to control infection and blood transfusion, infusion and other systemic support treatment. And stop oral, via gastric tube or jejunum ostomy supplies for nutrition. Small fistula may be healed. In severe infections, early repair of fistula is difficult to succeed. After a certain period of observation, such as unhealed fistula, can first external esophagus until the situation improved after the patients to consider the general line or substernal jejunal esophageal replacement with colon surgery.

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