Chinese to English: new operative method General field: Medical Detailed field: Medical: Instruments
Source text - Chinese 目前对食管上段癌常规均采用颈部入路作食管胃的颈吻合术以满足足够的切除长度，来保证切缘阴性，但手术复杂，步骤繁琐，并较易发生吻合口瘘。我们在既往超胸顶吻合的基础上结合颈部吻合器的使用探索并施行了“胸腔入路下的颈部器械吻合”手术新方法，效果良好，在此与同道一起探讨。“胸腔入路颈部器械吻合”即经由胸腔入路，在颈部腔道内实施食管胃的器械吻合，吻合完毕后吻合口位于颈部。
Translation - English Currently, the cervical approach is applied conventionally for the esophagus-stomach cervical anastomosis in operation for upper esophageal cancer to ensure the adequate incision length and negative margin. However, with this method the operation is quite complicated with many procedures and high risk of anastomotic leakage. We have explored and implemented the new operative method of “cervical stapled anastomosis by thoracic approach” based on the previous super-thoracic anastomosis method combined with using of cervical stapler  , obtaining satisfactory result. Here this article is also for further discussion with colleagues. “Cervical stapled anastomosis by thoracic approach” refers to implementing the esophagus-stomach stapled anastomosis in the cervical cavity by thoracic approach. The anastomotic stoma is located at the neck after anastomosis.
Clinical Data and Method
1. General Data:
The cervical stapled anastomosis by thoracic approach was made in 26 cases between Jul.2006 andAug.2009, with 18 males and 8 females. The age was 51~77with mean of 60.96±5.71. Determination by GI and gastroscopy was made before operation, and the Johnson & Johnson stapler (25) was used in all the cases. The control groups included the cases with the same disease (2000-2009) receiving the conventional operative methods, namely the manual anastomosis of by cervical incision, stapled anastomosis by cervical incision and super-thoracic anastomosis.
2. Method of “Cervical Stapled Anastomosis by Thoracic Approach”:
2.1. Anesthesia: Intravenous anesthesia with double-lumen
2.2. Posture: Right lateral position
2.3. Incision: The fifth intercostal posterolateral incision at left
2.4. Operation procedures:
2.4.1 Mobilization of thoracic esophagus: After opening the chest, the single lung ventilation was made for detelectasis of the left lung, followed by mobilizing the thoracic esophagus to thoracic apex with conventional method (up to the left subclavian artery crossing the thoracic apex). The right vagus nerve and concomitant vessels were ligatured and cut off.
2.4.2 Mobilization of stomach: For the higher fifth intercostal incision, we mobilized the stomach with the “gastric in-situ mobilization method”  (Fig.1). This mobilization method for gastric fundus and greater curvature is different from the conventional mobilization method. Operating with single hand, the fundus and greater curvature were mobilized from the upper polar of spleen towards pylorus. The stomach was lifted taking the splenco-gastric ligament and the gastrocolic ligament as pivot, and the lateral hemalarch of gastric fundus and greater curvature were mobilized to pylorus.
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