Nakamura S, Miyamoto Y, Ohwada S, Tanahashi Y, Takeyoshi I, Morishita Y
Second Department of Surgery, Gunma University School of Medicine, Maebashi, Japan.
Nihon Kyobu Geka Gakkai Zasshi. 1993 Jan;41(1):72-7.
A 56-year-old man with cancer of the mid-thoracic portion of the esophagus and who had a right aortic arch associated with a vascular ring, underwent esophagectomy and mediastinal lymphadenectomy successfully. A routine chest roentgenogram had revealed the right aortic arch. The entire thoracic esophagus was excised via a left thoracotomy, and the left subclavian artery, which originated from a diverticulum of the right descending aorta was located on the left side of the esophagus, ascending from its posterior aspect. The left subclavian artery and the left arterial duct formed a vascular ring which was interrupted by dividing the arterial duct. Histologically, the resected specimen showed poorly differentiated squamous cell carcinoma of the protruding type, and was classified as stage IV, a2, ly(+), V(-) and na(+). Successful mediastinal lymphadenectomy requires that the surgeon pay careful attention to vascular abnormalities, as well as the pathways of the vagal and recurrent nerves.
一名56岁男性，患有胸段中段食管癌，伴有右位主动脉弓及血管环，成功接受了食管切除术和纵隔淋巴结清扫术。常规胸部X线片显示了右位主动脉弓。经左胸切口切除整个胸段食管，起源于右降主动脉憩室的左锁骨下动脉位于食管左侧，从其后侧向上走行。左锁骨下动脉和左动脉导管形成一个血管环，通过切断动脉导管将其打断。组织学检查显示，切除标本为突出型低分化鳞状细胞癌，分类为IV期，a2，ly(+)，V(-)和na(+)。成功的纵隔淋巴结清扫术要求外科医生仔细关注血管异常情况以及迷走神经和喉返神经的走行路径。
