METHOD FOR TREATMENT OF PATIENTS WITH CARDIOESOPHAGEAL CANCER

摘要

FIELD: medicine.;SUBSTANCE: invention relates to medicine, namely to oncology. Based on the results of a comprehensive examination of the patient and the establishment of a diagnosis of cardioesophageal cancer, a decision is made on surgical intervention in the scope of performing a proximal resection of the stomach with resection of the distal esophagus within 10 cm of the indent from the esophageal-gastric junction. To do this, an upper midline laparotomy is performed with the continuation of the incision along the sixth intercostal space on the left, crossing the cartilaginous segments of the costal arch and diaphragm to the level of the esophageal opening. Then the abdominal organs are revised. Next, a proximal resection of the stomach is performed with the formation of a gastric tube from its stump with a diameter of 4 cm, which is moved into the left pleural cavity to the line of resection of the esophagus and the transected esophagus is wrapped with a mobile narrow gastric graft, as in Fig. 2. The resulting loop of the gastric graft is sutured with the esophagus and between themselves with interrupted nylon sutures, then the lumen of the gastric graft is opened, ten interrupted sutures are applied with absorbable suture material on the esophagus and the inner lip of the anastomosis. The outer lips of the gastric graft are sutured, thus avoiding the traditional intussusception of the esophagus into a narrow gastric graft due to the lateral echelon of the esophagus by the walls of the gastric stem duplication. After that, the thoracoabdominal wound is sutured layer-by-layer with mandatory drainage of the left pleural cavity with a Bülau drain with an inner diameter of 10 mm, after 7 days, contrasting of esophagogastroanastomosis with a solution of barium sulfate is carried out, with the consistency of the anastomosis and the absence of streaks of the contrast agent, the trapping drains are removed. ;EFFECT: method improves both immediate and long-term functional outcomes of operations due to reliability and functionality of the developed reservoir esophageal-gastric junction.;1 cl, 1 ex, 3 dwg