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Dołączył: 13 Gru 2010
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 Wysłany: Wto 0:28, 15 Mar 2011 Temat postu: Whole stomach through esophageal bed surgical expe |
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Whole stomach through esophageal bed surgical experience of 42 cases of graft
6 rib access incision into the chest, * 32 * will be free if the base of thoracic esophageal cancer is larger and the aortic arch or the azygos vein with the tight adhesion,[link widoczny dla zalogowanych], free hardship may cut the descending thoracic aorta on the left parietal pleura, cut off 2 3 ribs asked vein, the aortic arch to the front gently retracted to expose the aortic arch after the esophageal tumor and azygos vein, to look into the separation of mediastinal lymph nodes removed, open the diaphragm to free the stomach or duodenal pyloric . If the patient has poor lung function, do not cut the diaphragm, the cardia bar a traction line, traction to the head, cut off peritoneal cardia, esophageal hiatus through the diaphragm clamp, tie down the spleen and stomach ligament and short gastric vessels, and then off bar left gastric artery and vein, and then free the gastrocolic ligament. Chu hard cardiac and pleural resection of esophageal, gastric Ben closed the door. The gastric body along the lesser curvature of gastric folds, thick tubular joints shrunk. Ma at the highest point in the intended gastric anastomotic site and the midpoint on both sides, each stitch traction line. The stomach from the esophagus after aortic arch pull the bed, chest seam roof 3-pin traction esophageal stump line, connected with the stomach knotted cord traction. Re tired of esophageal hiatus, closed set g 【flow, sternal sternocleidomastoid anterior oblique left neck incision to free cervical esophagus, the stomach and be led to the neck, stomach, esophageal and gastric side underwent colostomy side anastomosis. Omental flap anastomosis, the stomach muscle and paddle around the neck tissue suture week. 0 【home rubber sheet flow, cut the neck stitching. Discussion we use the left thoracotomy through esophageal bed base neck anastomosis gastric transplant advantages are: (1) 2 incision, a dressing, a group of surgical personnel to complete surgery; surgery Lu shortened, reducing the surgical field pollution, invasive surgery to reduce copies. The past, we used three right chest incision, intraoperative process generally twist 6h, while the use of this technique Wu Miriam / 24-5h. (2) This means the skin over sternum, Qu bone active amidine and after the top of the bow chest SUI channels are short, do not worry if the length of Ning} dark long enough. r strongly to the esophageal bed closest to the original understanding of the village, on the respiratory and digestive function after surgery had little effect. And the aortic arch and thoracic aorta as its own barrier to prevent the expansion of thoracic stomach after surgery,[link widoczny dla zalogowanych], eliminating the after eating chest tightness, shortness of breath, palpitation and other symptoms. (3) After the free end to Breast esophagus and stomach, chest open and short exposure time of cardiopulmonary disturbance, light pollution in the chest. (4) cervical anastomosis easy operation, safety barrier, even if the anastomotic bury, generally not life-threatening. In addition, the lesion completely, and associated with left supraclavicular lymph node metastasis can be a parallel left supraclavicular lymph node dissection. L cases with the left in this group lock 'R' has been on the survival of patients with lymph node metastasis l7 months. (5) those with poor lung function may be cut Diao diaphragm, the diaphragm can be free of gastric esophageal hiatus. Encounter larger tumor, azygos vein and the aortic arch or tight adhesion, can be retracted free aortic arch under direct vision Zach separation or thread veins. Required by this surgical attention to the following questions: (1) free aortic arch, the cut should not be more than three intercostal artery; traction when the aortic arch slow light can not be hurried. (2) by Mian stomach and esophageal hiatus should be free to stomach ligaments as a breakthrough, the first thread bar the short gastric vessels, and then tie off the left gastric artery and vein,[link widoczny dla zalogowanych], the last relatively easy to free the gastrocolic ligament (3) reconstruction of septal esophageal hiatus, the need to will be put on the stomach as far as possible, and then suture the stomach and diaphragm. (4) access to the chest and neck wide enough to accommodate 3 refers to the best. Our experience, the incidence of cervical anastomotic bury more so narrow passageways oppressed stomach, so that anastomotic blood supply by the effects. Therefore, gastric and esophageal stump pull 【line traction line play thread firmly, pull the stomach to the neck when the action should be lightweight, so as not to disengage the line of junction, the stomach wall to tear off into the chest and stomach imitation. (5) free when cervical esophagus close to the esophagus,[link widoczny dla zalogowanych], so as to avoid the recurrent laryngeal nerve injury. After anastomosis to the stomach near the plasma AG level and sutured neck tissue a week in order to avoid anastomotic leakage into the chest or stomach after the dirt off into the chest. (Continued from page 2l) to discuss the short term a large number of flats in aplastic anemia, a rare root Bong is still at home and abroad because people lack of knowledge on the small chamber, ignorant of its dangers. Quebec mining in such a village-run enterprise that is especially true, so they will shop from a well-ventilated room to move tall people with low small room, and close: to avoid the H, thus increasing the concentration of dirty air to reach 20 times the national standard , which resulted in massive chronic poisoning. We treated the patient reed, while knocking in conjunction with local authorities on the stand about plant equipment and the transformation of the work environment; First, update the device to reduce the benzene song volatile small neoprene Kong Mountain in favor of King cavity j = is to improve the ventilation exhaust, quality of the air concentration of harmful male down below a specified; third is to strengthen the work of one's own uncle and the state protection such as wearing ∞ liquid gloves, take the above measures,[link widoczny dla zalogowanych], for nearly two years of follow-up, refuse plant similar to the patient no longer appeared .
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