Resection through left thoracic aortic arch esophagogastrostomy

By | March 22, 2012

Through left thoracic aortic arch resection of esophagogastric anastomosis (1) indications. Chest for most of the esophagus, the lower part of gastric cardia cancer and surgery, especially frail elderly and poor lung function in patients with multiple incisions should not be done, but also to the left lung function in very poor lung function had to keep or left lung lesion resection patients need the same time.
(2) advantages. An incision with a left chest and the removal of all can be fully free foot esophagus and stomach to the abdominal cavity at the same time to complete the free and the left gastric lymph node dissection, surgery does not require changing position, shortening the operative time, less damage to the patient, In particular, the elderly and those with poor physical condition is more useful.
(3) shortcomings. If the esophagus is located in the aortic arch, especially after the invasion outside the obvious, due to poor exposure, free and easy hurt when a tumor is the aortic arch and the azygos vein arch, causing bleeding. In addition, the incision of the mediastinal lymph nodes can not be completely removed.
Through left thoracic aortic arch resection of esophagogastric anastomosis (4) surgical approach. To ensure postoperative nutrition, preoperative indwelling gastric tube and feeding tube and feeding tube into the surgery will duodenum.
a. position, incision. Right lateral position, after the lateral chest incision, removal of rib 6, which can cut off the ribs after the first 5 paragraphs, the threat of bed into the chest.
b. exploring the tumor. Traction within the party to lung forward to expose the posterior mediastinum, carefully exploring the tumor's size, activity, relationship with surrounding organs and lymph node metastasis. If the tumor has invaded the hilar organs or aorta, or a more extensive lymph node metastasis, has not removed. If the tumor has some activity, no such signs, the longitudinal cut mediastinal pleura, pulmonary ligament under separate, finger into the incision to the tumor adjacent to mediastinum try to stir up; such as tumor activity with the fingers, and in the lung between the aorta and spinal doors and sliding, that the tumor has not foreign invasion, to cut; such activity is not very clear, both inside and outside the finger probe in the mediastinum and around the organs of their relations, such as the gap is still palpable out some of asked that There may be removed. Consider the possible removal of the initial post, with your fingers around the esophagus at the tumor site under the line of separation of exploratory and esophageal hook out around the hose to valuables (preferably not tape) to do traction, usually will be on the muscle from the leap esophageal branches from the aorta were isolated, cut off after the ligation of 1 – 2 branch, part of the separation of the tumor, easy to detect, further clarify the situation. This separation should be in moderation, such as a beginning, all the isolated tumors, breast muscle may be found in the abdominal incision has been widely transferred, indicating that the removal of the tumor has been useless, but the tumor has been fully separated, the esophageal blood supply is cut, only forced were ineffective surgery.
c. cut brain muscle. In the liver, spleen and between parts of the brain with the two mentioned muscle tissue forceps, cut between two clamps, and then extended along the radial direction, the front until near the costal arch, the back-end point to esophageal hiatus. In order to reduce bleeding and prevent brain damage following organ, the brain with the fingers cut to boot to the lift, while cutting edge bleeding. Place in the last hole, a preserved artery branches, each with a coarse thread should be "8"-shaped suture. Leave some needles on both sides of the incision as a traction suture. Who then reached the abdominal cavity exploration fundus, greater curvature of the stomach and small bend, liver, spleen door, left gastric artery and abdominal aorta around the omentum, mesentery and pelvic lymph node metastasis or tumor transplantation. If by the thoracic and abdominal exploration or palliative resection of a clear operation can be, you can expand the brain muscle incision esophageal hiatus.
d. part of the separation of the duodenum. Such as the location of the tumor higher, sometimes cut the descending part of the peritoneum lateral and blunt separation of the posterior wall of the duodenum, so that the full separation of the stomach, to have sufficient length, or in the chest at the top neck and esophageal anastomosis.
Resection through left thoracic aortic arch esophagogastrostomy e. cut cardia. Above the level of inferior pulmonary vein esophageal cancer, such as without prejudice to the lymph nodes removed, the stomach should be retained. Generally cut off at the cardia to the esophagus, stomach resection without having to do. Then, in the cardia placed two toothed clamp, cut between two clamps. Esophageal stump sutured to the esophagus close to do thick, then put on rubber finger cots or condoms dressing. 2-3 pin end of the stomach to do full-thickness mattress suture thread, coupled with intermittent muscle thin paste made of inverted suture, the stomach closed. When the tumor location is high, can also be cut off at the cardia of about 2cm esophagus, distal esophagus with a thick line under the clamp ligation, and then do ring suture in the fundus, the stump fell into the stomach to tighten the purse line, pulp plus intermittent muscular closure, will temporarily remain in the stomach and abdomen.

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