Transcervical, sternotomy and abdominal approach esophagogastric anastomosis

At present, the use of esophageal cancer for esophagogastric neck anastomosis is gradually increasing. The neck anastomosis not only increases the length of esophageal resection, but also reduces the chance of residual cancer in the esophageal end of the tumor, and it is easy to handle even if an anastomotic fistula occurs, and it is not life-threatening. Common neck anastomosis methods are: 1 left chest esophagectomy, left neck esophagogastric anastomosis; 2 right chest esophagectomy, right neck esophagogastric anastomosis; 3 non-open thoracic esophagectomy, esophagogastric neck anastomosis ; 4 through the neck, sternotomy and abdominal path esophagogastric anastomosis; 5Kirschner surgery. Treating diseases: esophageal cancer Indication Transesophageal and sternal dissection and abdominal path esophagogastric anastomosis are applicable to: 1. Upper esophageal cancer. 2. Upper middle esophageal cancer (the lesion is adjacent to the aortic arch, and it is estimated that the finger separation can be completed). Preoperative preparation The preparation range includes neck, chest and abdomen. Surgical procedure 1. The incision is inclined along the anterior border of the sternocleidomastoid muscle to the midpoint of the sternal notch, and then to the midline of the sternum, ending at the plane of the fourth costal cartilage. The neck incision is generally 4 ~ 5cm, the skin and subcutaneous tissue can be cut, the sternum is opened in the middle, and the third intercostal space is transected. The periosteum is electrocoagulated to stop bleeding and the bone wax bone marrow cavity stops bleeding. 2. Open the open sternum, and bluntly separate the pleural membranes on both sides to avoid damage to the pleura and cause pneumothorax. Push the pleura and adipose tissue to the sides and dissect the neck incision to reveal the upper mediastinum. If the left unnamed vein affects the operation, it should be ligated and cut. Above the aortic arch (or above the left innominate vein), the trachea and esophagus are revealed between the innominate artery and the left carotid artery. If the tumor is above the aorta, it can be explored under direct vision to determine the size, activity, and relationship with adjacent tissues. If the tumor is located under the aortic arch, the esophageal and spinal gaps can be explored first, followed by exploration of the esophageal tracheal space. If the tumor adheres to the surrounding tissue is not serious, it is easy to separate with the finger, indicating that the tumor can be resected, the tumor and the surrounding tissue are fully freed, and the normal esophagus is released to the neck until the required length. The nearby adipose tissue, including the lymphatic and fat pads of the bilateral supraclavicular region, is removed. 3. The mid-abdominal incision enters the abdominal cavity, the stomach is fully dissociated, the cardia is pulled with a cloth belt, and the lower esophagus is separated by fingers through the esophageal hiatus. Cut a small mouth on the normal esophagus above the tumor, put the probe into the stomach through the mouth, ligature the thick wire at the end of the esophagus, cut the cardia, and leave the probe to the outside of the esophagus, and then pull it up from the neck. Esophageal spit, the esophagus is turned upside down. When the tumor is removed to the tumor site, the tumor tissue is hard and fragile, and the forced stretching is easy to break. The tumor can be fully dissociated, and then the tumor and the exfoliated esophagus are lifted together to the neck. Right angle forceps clamp the esophagus above the entrance of the esophageal probe, remove the esophagus and tumor, and perform esophagogastric anastomosis. 4. After closing the cardia, lift the fundus to the neck through the esophageal bed and perform an esophagogastric anastomosis. 5. Layered suture of the abdomen and neck and chest. The open sternum is sutured with stainless steel wire, and a latex or silicone rubber tube is placed in the mediastinum, and a small incision is made in the left rim of the third intercostal space to connect the water seal bottle or negative pressure drainage.