Method for carrying out plastic repair of the esophagus

FIELD: medicine.

SUBSTANCE: method involves carrying out left-side laparophrenotomy. Esophagus and stomach stump extirpation is carried out. Large intestine is conducted in the posterior mediastinum. Distal end-to-end anastomosis of transplant and the duodenum is created using atraumatic sutures.

EFFECT: enhanced effectiveness of plastic repair in the cases of resected stomach cancer.

1 dwg

 

The invention relates to medicine, namely to surgery

The known method plastics esophagus lower third with proximal gastrectomy, including access to the stomach and lower thirds of the esophagus through the left laboratorycreative followed by resection of the lower third of the esophagus and stomach (Atlas of Oncology operations, edited by Beilenson, Vigesaa, Aeacea. Moscow, 1987, page 279)

However, when this method is used only for the purpose of resection of the lower third of the esophagus Izlude and eksterpatsii stomach.

Closest to the proposed method simultaneously eksterpatsii esophagus and plastics his colon using zadnelateralnuu ways of holding the graft in place of the esophagus, leaving the stump of the operated stomach (esophagoplasty. - Afernoon, Woundring, Ski, Sagarai. Analy, scientific center of surgery, Moscow, 1993, Issue 2).

However, this method plastic surgery of the esophagus is impossible in cancer rezitsirovannogo stomach and lower thirds of the esophagus.

The technical result of the invention is plastic esophagus colon in cases where other options are plastic esophageal impossible, and improving the quality of life of cancer patients.

The technical result is achieved by the fact that access to the esophagus and the stump of the stomach, bearing a tumor, through the left laboratorycreative, outstanding gastro-esophageal junction, bearing a tumor, highlighted the stump of the stomach and the esophagus to the upper aperture of the thorax, through an incision on the inner edge of the left sternocleidomastoid muscle is allocated cervical esophagus, mobilized suitable for the plastics division of the colon, is extirpate of the esophagus and the stomach stump, colonic graft is performed in the posterior mediastinum and laid in the bed of the remote esophagus, the proximal end of the graft is connected with the stump of the esophagus by the method of hand joint, the distal end of the graft is connected with the stubs of the duodenum (DICK) by the method of "end-to-end double-row manual the atraumatic suture thread. The left pleural cavity, mediastinum, abdominal cavity is drained silicone drains, wounds of the diaphragm, thorax and anterior abdominal wall is sutured tightly.

The technical result is achieved by the fact that access to the esophagus and the stump of the stomach, bearing a tumor, through the left laboratorycreative (see drawing) is allocated to the gastroesophageal junction, bearing a tumor, 1 are allocated to the stump of the stomach and the esophagus to the upper aperture of the thorax, through an incision on the inner edge of the left sternocleidomastoid muscle stands out is any the esophagus, mobilized suitable for the plastics division of the colon, is extirpate esophagus 2 and gastric stump 3, colonic graft is performed in the posterior mediastinum and laid in the bed of the remote esophagus, the proximal end of the graft is connected with the stump of the esophagus method manual seam 4, the distal end of the graft is connected with the stubs of the duodenum (duodenum) by the method of "end to end" manual double-row suture atraumatic thread 5. The left pleural cavity, mediastinum, abdominal cavity is drained silicone drains, wounds of the diaphragm, thorax and anterior abdominal wall is sutured tightly.

Example. Patient B., born in 1936 was admitted with a diagnosis of cancer N/3 of the esophagus, the relapse, the state after proximal gastrectomy (2000). Was hospitalized with 11.09.01 on 1.11.01.

Patient 22.9.01 transaction: angle cut with the transition to the chest on the seventh Mirabello layers penetrated the abdominal and pleural cavities were diaphragmlike, with the technical difficulties of adhesions selected infiltrate, which goes on the stump of the stomach and rising up the esophagus to the root of the lung. Uninstalled stump of the stomach and esophagus. Given the vascular architecture of the prepared graft from your colon and sigmoid colon on sudiste leg. The graft is moved into the mediastinum and placed on the neck in retroperitoneal position. Imposed anastomosis between the graft and the stump of the esophagus in the neck by a double seam atraumatic thread. The distal anastomosis between the graft and duodenum imposed “end to end” double row of hand stitching. The integrity of the colon restored by the imposition of colonic manual double anastomosis “end to end”. Aperture stitched capron, wounds of the abdominal and chest wall sutured tightly after installing drains in the abdominal and pleural cavity on the left. The patient is in satisfactory condition and was discharged for outpatient treatment, at discharge, no complaints, eat any food, dysphagia no.

The use of the proposed method to produce plastic esophageal cancer resected stomach and to improve the quality of life of these patients.

The way plastics esophagus, including access to the stump of the stomach and the esophagus through the left laparothorakoskopie followed by extirpation of the stomach stump and plasticity of the esophagus colon with holding her in the posterior mediastinum, characterized in that the extirpation of the esophagus is performed through the left laparothorakoskopie with its subsequent plasticity colon with the imposition of the distal anastomosis of the graft with dvenadtsatyi the Noah gut the end of the atraumatic sutures.



 

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