Presentation on theme: "Diseases of the esophagus Attila Enyedi MD.. Anatomy of the oesophagus I. 38-40 cm lenth, (upper-middle-lower ) Blood supply: inf.thyreoid a., direct."— Presentation transcript:
Anatomy of the oesophagus I. 38-40 cm lenth, (upper-middle-lower ) Blood supply: inf.thyreoid a., direct arteries from the aorta, bronchial, gastric & phrenic arteries Cervical, cardial, celiac lymphnodes, Jumping metastases UES,LES (upper-lower oesophageal sphincter) No serosa 16-2424-3232-40
Perforation the oesophagus Diagnosis (in general late) Case history –Bone, fishbone, previous interventions Physical examination Swallowing X-ray CT (contrast enhanced) Endoscopy????
Perforation the oesophagus Treatment Conservative –AB, relieving nasogastric tube, stenting Surgery –Suture (in early stage) + covering of the suture –Drainage (mediastinotomy, Chest tube drainage) –Resection with cervical oesophagostomy (Thorec operation) –Transgastric drainage
Treatment of oesophageal cancer Radiotherapy Chemotherapy Surgery Protocol Resection than adjuvant chemo-radiotharpy Neoadjuvant chemo-radiotherapy than resection, than chemo-raditherapy Palliative treatment
Oesophageal tumours Suegical treatment Transthoracal or transhiatal resection Subtotal resection of the oesophagus Oesophago-gastrostomy (cervical or intrathoracic) Feeding and decompression jejunostomy
Contraindication of radical resection Distant metastasis (eg. Liver, lung) Local spread to the surrounding organs –Aorta –Bronchial tree (oesophago-tracheal fistula) Poor general condititon Severe concomitant disease –Cirrhosis hepatic –Ischemic heart disease –poor lung function
Palliative treatment of oesophageal cancer R 1 resection, than adjuvans chemo- radiotharpy? Stenting Feeding gastro/jejunostomy –Via laparotomy –PEJ/PEG
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