METHOD OF ESOPHAGUS RESECTION IN PATIENTS WITH MALIGNANT ESOPHAGEAL FISTULA Russian patent published in 2020 - IPC A61B17/00 

FIELD: medicine.

SUBSTANCE: invention relates to medicine, specifically to oncology and surgery. On the right, in the seventh intercostal space 1 cm outside of the scapular line, install a valveless trocar with diameter of 10 mm, in the fifth intercostal space on the middle axillary line a valveless trocar is placed with diameter of 12 mm, and a valveless trocar of diameter 5 mm in the ninth intercostal space along the posterior axillary line on the right. Ultrasonic scalpel is used to dissect a mediastinal pleura between an esophagus and a pericardium, a right lung gut, a trachea, wherein separation of the mediastinal pleura begins from the diaphragm. Esophagus is mobilized above and below the tumor so that its lateral wall is visible. Further, the mediastinal pleura is dissected between an esophagus and a hemiazygos vein, and a dissection is performed from a hemiazygos vein. Then a hemiazygos vein is clipped and crossed. Mediastinal pleura is dissected to a right subclavian artery between an esophagus and a backbone. Esophagus is taken to the gauze hanger above and below the tumor site. Esophagus is crossed in a dome of the right pleural cavity and traction in caudal direction behind a distal end of the crossed esophagus is performed; it is mobilized and esophageal vessels are transected. Distal end of the esophagus below the fistula and the tumor is transected; the preparation is removed. Pleural cavity is washed with warm physiologic saline of sodium chloride. Further behind the right lung and in the dome of the pleural cavity along the anterior surface of the right lung, tube 1 cm in diameter is attached to the costal-diaphragmal sine of PHV. Patient is turned on his / her back and performed Witzel gastrostomy and cervicotomy to the left along the anterior edge of the sternocleidomastoid muscle, end esophagostomy.

EFFECT: method enables performing esophageal excision in weakened and age patients with malignant esophageal fistula, reducing traumatism, improving treatment results in this category of patients.

3 cl, 1 ex, 4 dwg