Dong W Z
Affiliated Hospital, Changzhi Medical College.
Zhonghua Zhong Liu Za Zhi. 1989 Jan;11(1):50-2.
Isolation traction of aortic arch and upper part of thoracic aorta was performed by pulling and rotating them rightwards during operation on cancer located in the mid-segment of esophagus with serious adhesions. In 35 patients operated on, 33 cancers were resected with resection rate of 94%, including 21 by radical resection (60%) and 12 by palliative operation (34%). The method was to isolate the aortic arch and the upper part of thoracic aorta sufficiently and ligate the severed intercostal arteries and veins securely. While isolating the aorta, we pulled and rotated it with a strip of bandage and exerted strength evenly and gently as long as the operation field was exposed clearly. Otherwise, the heart function may be compromised. When isolating the aorta, a slight drop of blood pressure could be observed in some cases. It could recover immediately as we stop pulling and replaced the aorta in situ. According to our clinical experience, its advantages were: 1. It can prevent and treat the bleeding of hemiazygos vein. None of the 33 patients with adhesion and infiltration between the tumor and hemiazygos vein bled during the operation, even with the hemiazygos vein torn and bleeding. Bleeding could be stopped with ease because of good exposure; 2. It can extend the limit of resection and raise the resection rate; 3. It can broaden the space between the aorta and esophagus which is convenient for esophagogastrostomy on the esophagus bed, and 4. It can secure ligation of thoracic duct to prevent chylothorax.
对于位于食管中段且粘连严重的癌症患者，在手术过程中通过向右牵拉和旋转主动脉弓及胸主动脉上部进行隔离牵引。在35例接受手术的患者中，33例癌症被切除，切除率为94%，其中21例为根治性切除（60%），12例为姑息性手术（34%）。方法是充分隔离主动脉弓和胸主动脉上部，并牢固结扎切断的肋间动静脉。在隔离主动脉时，用一条绷带牵拉并旋转它，只要手术视野清晰就均匀轻柔地用力，否则可能会损害心脏功能。在隔离主动脉时，部分病例可观察到血压略有下降，停止牵拉并将主动脉复位后可立即恢复。根据我们的临床经验，其优点为：1. 可预防和治疗半奇静脉出血。33例肿瘤与半奇静脉有粘连和浸润的患者在手术中均未出血，即使半奇静脉撕裂出血，由于暴露良好也能轻松止血；2. 可扩大切除范围并提高切除率；3. 可拓宽主动脉与食管之间的间隙，便于在食管床进行食管胃吻合术；4. 可牢固结扎胸导管以预防乳糜胸。
