Omura K, Urayama H, Kanehira E, Kawakami K, Ohtake H, Kosugi I, Inaki N, Watanabe Y
Department of Surgery (1), Kanazawa University, Faculty of Medicine, School of Medicine, Japan.
J Surg Oncol. 1998 Oct;69(2):113-6. doi: 10.1002/(sici)1096-9098(199810)69:2<113::aid-jso13>3.0.co;2-u.
This report describes the surgical procedure consisting of larynx-preserving resection of the cervical esophagus and satisfactory lymphadenectomy. The sternum was split at the level of the 3rd intercostal space, which allowed an upper-mediastinal lymphadenectomy to be performed easily. The cervical esophagus was reconstructed using a free jejunal autograft. The stump of the thoracic esophagus and the caudad stump of the jejunal graft were anastomosed using a circular stapling instrument. The posterior part of the cephalad esophagojejunostomy was completed in two layers using the Lembert stitch. The wall of the cervical esophagus was opened to determine the oral cut line considering the safety margin from the carcinoma. After cervical esophagectomy was completed, suturing of the anterior wall was performed in one layer. The left cervical transverse artery and the internal jugular vein were employed for recipient vessels. This procedure is acceptable for high cervical esophageal carcinoma limited to the submucosal layer.
本报告描述了一种手术方法，包括保留喉的颈段食管切除术和满意的淋巴结清扫术。胸骨在第3肋间水平劈开，便于轻松进行上纵隔淋巴结清扫术。使用游离空肠自体移植重建颈段食管。用圆形吻合器将胸段食管残端与空肠移植体的尾侧残端进行吻合。食管空肠吻合口的头侧后壁用伦伯特缝合法分两层完成。切开颈段食管壁，考虑癌肿的安全切缘来确定口侧切线。完成颈段食管切除术后，前壁进行单层缝合。采用左颈横动脉和颈内静脉作为受体血管。该手术方法适用于局限于黏膜下层的高位颈段食管癌。
