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Full text of "Diseases Of The Nose Throat And Ear"

DYSPHAGIA

For the past 8 years the author has preferred to use stomach to replace
oesophagus removed in the treatment of this cancer. The larynx and pharynx
are freed from the base of the tongue, the trachea is transected around the
fourth ring and the oesophagus is freed by finger dissection down to the level
of the left main bronchus. The abdomen is opened, the stomach freed and
pedicled on the gastro-epiploic artery and the right gastric artery, the vagus
nerve divided, a pyloroplasty done and the lower half of the oesophagus freed
by blunt ringer dissection. When the oesophagus has been freed, the top end of
the specimen is gently pulled and the stomach is drawn through the posterior
mediastinum into the neck. The oesophagus is divided from the stomach at
the cardia and the fundus of the stomach is joined on to the base of the
tongue and posterior pharyngeal wall. The pylorus lies then at the cardia.
Only if neck glands are palpable is a radical neck dissection done; otherwise an
expectant policy is adopted. The use of this operation as a salvage procedure
rescues about 1 in 4 recurrences.

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