Stephen S J, Uragoda C G
Thorax. 1972 Mar;27(2):228-31. doi: 10.1136/thx.27.2.228.
The frequency of oesophageal carcinoma in Ceylon provides an opportunity for elaborating certain modifications in the technique of oesophageal resection. Initial subadventitial ligation of oesophageal branches of the aorta renders the operative field relatively bloodless, thus facilitating the removal en bloc of the tumour together with the lymphatic and loose cellular tissue, as well as the adventitia of the aorta when it is involved. The division of the oesophagus above the growth in an oblique plane, leaving a posterior flap, helps to minimize the incidence of fibrous strictures and anastomotic leaks. In fashioning the stomach tube, the stomach is divided just proximal to the beginning of the left gastro-epiploic arch. This procedure ensures that the blood supply to the gastric component of the oesophagogastric anastomosis is least disturbed. In cases where the transverse colon and hepatic flexure are used as an interposition, a dual blood supply derived from the middle colic as well as the ascending branch of the left colic artery is retained. This procedure increases the margin of safety in case one artery obstructs.
锡兰食管癌的发病情况为改进食管切除术的技术提供了契机。首先对主动脉食管分支进行外膜下结扎，可使手术视野相对无血，从而便于将肿瘤连同淋巴组织、疏松细胞组织以及受累时的主动脉外膜一并整块切除。在肿瘤上方以斜行平面切断食管，保留后侧皮瓣，有助于将纤维性狭窄和吻合口漏的发生率降至最低。制作胃管时，在胃左网膜弓起始部近端将胃切断。这一操作可确保食管胃吻合术中胃部分的血供受干扰最小。在使用横结肠和肝曲作为间置物的病例中，保留源自中结肠动脉以及左结肠动脉升支的双重血供。若一条动脉受阻，此操作可增加安全 margin。 （注：原文最后一个词margin翻译为“余地”更合适，结合语境这里可理解为安全余地，但按要求不添加解释说明所以直接翻译为“margin” ）
