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Diseases of Diseases of the esophagusthe esophagus
Department of faculty and hospital surgery Department of faculty and hospital surgery Tashkent Medical AcademyTashkent Medical Academy
Diseases of the esophagus
Occupies the 6th place In the structure of
human diseasesOn the 3rd place
Among diseases of gastro - intestinal
tract (after disease Of stomach and rectum)
The incidence rates of esophageal population in 2010 year
(100 thousand)
Incidence of malignant tumors In 2010 year in the Republic of Uzbekistan
History of surgical treatment of esophageal-
is starting with 1877., When Vincenz Cherny
conducted the first successful resection of the cervical esophagus
Vincenz Czerny (1842 − 1916)
Only in 1913, Franz Torek first successfully
performed transtorakaling resection of the
esophagus (through the left torakotomtion
access) cancer middle chest
Franz J. A. Torek (1861-1938)
Transthoracic access to the clinic tried to apply Johannes
von Mikulicz (1904), Ernst Sauerbruch (1905), but these attempts were unsuccessful
Johannes von Mikulicz-Radecki 1850 - 1905
Peter A. Herzen (1871-1947)
Sergey Yudin (1891-1954)
Mikhail Davydov
Ivan Greeks (1867-1934)
Vasit Vakhidovich Vahidov
Shavkat Ibrahimovic Karimov
Nikolai Fedorovich Krotov
Sadik Aliyevich Masumov
Duties of the general practitioner in diseases Duties of the general practitioner in diseases of the esophagusof the esophagus
- Provision of primary health and social care; - Provision of primary health and social care; - Health education (promoting healthy lifestyles); - Health education (promoting healthy lifestyles); - Preventive work (timely detection of early and latent forms of the - Preventive work (timely detection of early and latent forms of the
disease, risk groups); disease, risk groups); - Dynamic monitoring; - Dynamic monitoring; - Emergency assistance in case of emergency and acute conditions; - Emergency assistance in case of emergency and acute conditions; - Timely consultation and hospitalization in the prescribed manner; - Timely consultation and hospitalization in the prescribed manner; - Medical and rehabilitation work in accordance with the qualifying - Medical and rehabilitation work in accordance with the qualifying
characteristic; characteristic; - An examination of temporary disability; - An examination of temporary disability; - The organization of medical and social care and household - The organization of medical and social care and household
together with the bodies of social protection and services of mercy together with the bodies of social protection and services of mercy alone, the elderly, the disabled, the chronically ill; alone, the elderly, the disabled, the chronically ill;
- Maintaining the approved forms of records and reports.- Maintaining the approved forms of records and reports.
Anatomy of the esophagus
Tracheal Tracheal Aortic Aortic Bronchial Bronchial Aorto-bronchial Aorto-bronchial EpibronhialEpibronhial Retropericardial Retropericardial Supradiaphragmatic Supradiaphragmatic Intradiafragmal Intradiafragmal AbdominalAbdominal
Anatomical region and part of the esophagus
1. The cervical 2. Hilar department a. The upper part of the
chest b. The average breast
part. c. The lower part of the
chest (including abdominal esophagus).
Blood circulation and the lymphatic system of the esophagus
branches of the lower thyroid artery
branches of the thoracic aortic
bronchial artery
ascending branch left gastric artery
Metastasis
Methods of study of the Methods of study of the esophagusesophagus
Methods of study of the Methods of study of the esophagusesophagus
1.1. Radiographs Radiographs
2.2. Endoscopic examination Endoscopic examination
3.3. Radioisotope study (external and Radioisotope study (external and intraluminal) intraluminal)
4.4. Ultrasound examinationUltrasound examination
5.5. Intraesophageal pH-meters Intraesophageal pH-meters
6.6. The study of motorThe study of motor
Endoscopic method of Endoscopic method of investigation of the investigation of the
esophagusesophagus
Endoscopic method of Endoscopic method of investigation of the investigation of the
esophagusesophagus
X-ray method for studying X-ray method for studying the esophagusthe esophagus
X-ray method for studying X-ray method for studying the esophagusthe esophagus
Classification of diseases of the Classification of diseases of the esophagusesophagus
Classification of diseases of the Classification of diseases of the esophagusesophagus
I. Malformations I. Malformations 1 Congenital esophageal atresia and esophageal-tracheal 1 Congenital esophageal atresia and esophageal-tracheal
fistulafistula 2 Congenital stenosis of the esophagus 2 Congenital stenosis of the esophagus 3 Congenital diaphragm membrane of the esophagus 3 Congenital diaphragm membrane of the esophagus 4 Congenital short esophagus 4 Congenital short esophagus 5 Congenital esophageal cyst 5 Congenital esophageal cyst 6 Anomalies vessels 6 Anomalies vessels II. damage II. damage 1 Traumatic injuries - interior and exterior 1 Traumatic injuries - interior and exterior 2 Burns of the esophagus and their consequences 2 Burns of the esophagus and their consequences III. diseases of the esophagus III. diseases of the esophagus 1 diverticula - pulse and traction 1 diverticula - pulse and traction 2 Inflammatory diseases - esophagitis 2 Inflammatory diseases - esophagitis IV. Tumors of the esophagus IV. Tumors of the esophagus 1 Benign tumors 1 Benign tumors 2 Cancers 2 Cancers V. Violation of esophageal motility (cardiospasm) V. Violation of esophageal motility (cardiospasm) 1 Achalasia 1 Achalasia 2 esophagism2 esophagism
The frequency of lesions of the The frequency of lesions of the esophagusesophagus
The frequency of lesions of the The frequency of lesions of the esophagusesophagus
Cancer Cancer Sarcoma Sarcoma Polyps Polyps Cardiospasm Cardiospasm Cicatricial stricture Cicatricial stricture Diverticula Diverticula Esophagitis Esophagitis Tuberculosis Tuberculosis SyphilisSyphilis
60-80
0,04
0,04
5,1
0,7
0,6
0,2
0,02
0,08
Esophageal cancer is 3.4% of all malignant neoplasms
DysphagiaDysphagiaDysphagiaDysphagia
Grade IGrade I - pass any food, but swallowing solid - pass any food, but swallowing solid food there are unpleasant sensations (burning, food there are unpleasant sensations (burning, scratching, sometimes pain) scratching, sometimes pain)
Grade IIGrade II - solid food stays in the esophagus and - solid food stays in the esophagus and passes with difficulty, it is necessary to wash passes with difficulty, it is necessary to wash down solid food with water down solid food with water
Grade IIIGrade III - solid food does not pass. When you - solid food does not pass. When you try to swallow it arises regurgitation. Patients try to swallow it arises regurgitation. Patients are fed liquid and semi-liquid food are fed liquid and semi-liquid food
Grade IV Grade IV - the esophagus to pass only liquid - the esophagus to pass only liquid Grade VGrade V - complete obstruction of the - complete obstruction of the
esophagus. Patients are unable to swallow a esophagus. Patients are unable to swallow a sip of water, does not pass even the salivasip of water, does not pass even the saliva
Types of congenital esophageal Types of congenital esophageal atresiaatresia
Types of congenital esophageal Types of congenital esophageal atresiaatresia
Esophageal corpus alienum
Esophageal corpus alienum
Esophageal-bronchial
fistula
Esophageal-bronchial
fistula
Excision of the esophageal-Excision of the esophageal-bronchial fistulabronchial fistula
Excision of the esophageal-Excision of the esophageal-bronchial fistulabronchial fistula
Degree of burns of the Degree of burns of the esophagusesophagus
Degree of burns of the Degree of burns of the esophagusesophagus
Grade IGrade I - redness and swelling - redness and swelling of the mucous membrane of the mucous membrane
Grade IIGrade II - the defeat of the - the defeat of the mucosa and submucosa mucosa and submucosa
Grade IIIGrade III - the defeat of all the - the defeat of all the shells of the esophagusshells of the esophagus
Factors determining the Factors determining the degree of damage to the degree of damage to the
esophagus a burnesophagus a burn
1 The nature of the received 1 The nature of the received material material
2 Number of received material 2 Number of received material 3 Concentration of the solution 3 Concentration of the solution 4 Consistency received 4 Consistency received
substance substance 5 Individual sensitivity to the 5 Individual sensitivity to the
received substancereceived substance
The clinical picture of burns of the The clinical picture of burns of the esophagusesophagus
The clinical picture of burns of the The clinical picture of burns of the esophagusesophagus
Acute stage (5-10 days),Acute stage (5-10 days), pain in the mouth, pharynx, pain in the mouth, pharynx, behind the breastbone, in the epigastric region. behind the breastbone, in the epigastric region. Hypersalivation. dysphagia, shock in the next few hours Hypersalivation. dysphagia, shock in the next few hours after the injury. Burn toxemia after a few hours begins to after the injury. Burn toxemia after a few hours begins to prevail prevail
Step imaginary well-being (7-30 days)Step imaginary well-being (7-30 days) as a result of as a result of rejection of the necrotized esophageal webs around the rejection of the necrotized esophageal webs around the end of the 1st week is somewhat looser. Complications: end of the 1st week is somewhat looser. Complications: esophageal bleeding, perforation of the wall of the esophageal bleeding, perforation of the wall of the esophagus, in the presence of extensive wound surfaces esophagus, in the presence of extensive wound surfaces develops sepsis develops sepsis
Stage of formation of the stricture (from 2 to 6 Stage of formation of the stricture (from 2 to 6 months, sometimes years)months, sometimes years) on the wall of the esophagus on the wall of the esophagus ulcers of different sizes. Wound surface covered with a ulcers of different sizes. Wound surface covered with a scab, bleed easily. Dysphagia can reach the degree of scab, bleed easily. Dysphagia can reach the degree of complete obstruction of the esophagus. When top complete obstruction of the esophagus. When top strictures: laryngospasm, coughing, choking due to spillage strictures: laryngospasm, coughing, choking due to spillage of food into the airwayof food into the airway
Burns and scar strictures of Burns and scar strictures of the esophagusthe esophagus
Burns and scar strictures of Burns and scar strictures of the esophagusthe esophagus
Short burn stricture at pharyngeoesophageal
transition
Short burn stricture of the middle third of the esophagus
Extended burn stricture of the
esophagus
Burns and scar strictures of Burns and scar strictures of the esophagusthe esophagus
Burns and scar strictures of Burns and scar strictures of the esophagusthe esophagus
Complications caused by chemical burns of Complications caused by chemical burns of the esophagusthe esophagus
Complications caused by chemical burns of Complications caused by chemical burns of the esophagusthe esophagus
Early shock laryngeal edema hemolysis
Older stricture depletion
pulmonaryEarly acute tracheobronchitis pneumonia Esophageal-bronchial fistula
Older pneumonia lung abscess bronchiectasis Esophageal-bronchial fistula
Perforation mediastinitis pericarditis empyema bleeding
Other foreign bodies diverticula Hiatal hernia Cancer of the esophagus Complications of dilatation
anemia
sepsis
Treatment of burns of the Treatment of burns of the esophagus in the acute periodesophagus in the acute period
Treatment of burns of the Treatment of burns of the esophagus in the acute periodesophagus in the acute period
1.1. Neutralize poison Neutralize poison
2.2. Removal of intoxication and pain Removal of intoxication and pain
3.3. Normalization of water-salt metabolism Normalization of water-salt metabolism
4.4. Anti-inflammatory therapy Anti-inflammatory therapy
5.5. Parenteral nutrition Parenteral nutrition
6.6. Normalization function of the Normalization function of the cardiovascular system cardiovascular system
7.7. Normalization of renal function Normalization of renal function
8.8. Prevention of respiratory disorders Prevention of respiratory disorders
9.9. Oral CareOral Care
Probing of the esophagusProbing of the esophagusProbing of the esophagusProbing of the esophagus
Segmental esophagoplasty Segmental esophagoplasty coloncolon
Segmental esophagoplasty Segmental esophagoplasty coloncolon
Esophagoplasty stomachEsophagoplasty stomach
Esophagoplasty with stomachEsophagoplasty with stomach
Esophageal diverticulaEsophageal diverticulaEsophageal diverticulaEsophageal diverticula
Esophageal diverticulaEsophageal diverticulaEsophageal diverticulaEsophageal diverticula
Esophageal diverticulaEsophageal diverticulaEsophageal diverticulaEsophageal diverticula
Esophageal diverticulaEsophageal diverticulaEsophageal diverticulaEsophageal diverticula
Complications of Complications of esophageal diverticulaesophageal diverticula
1 Diverticulitis - 85.2% 1 Diverticulitis - 85.2% 2 Intestinal obstruction - 6.5% 2 Intestinal obstruction - 6.5% 3 Bleeding - 4.3% 3 Bleeding - 4.3% 4 Perforation or penetration - 3.2% 4 Perforation or penetration - 3.2% 5 Tumor development - 0.8%5 Tumor development - 0.8%
Removal of esophageal Removal of esophageal diverticulumdiverticulum
Classification of reflux Classification of reflux esophagitisesophagitis
Classification of reflux Classification of reflux esophagitisesophagitis
I. Primary I. Primary Primary disorders of the nervous and peptide Primary disorders of the nervous and peptide
(gastrin, histamine, motilin, etc..) Regulation (gastrin, histamine, motilin, etc..) Regulation of motility of the esophagus and the stomach of motility of the esophagus and the stomach
II. Secondary II. Secondary When hiatal hernia, pyloric stenosis, peptic When hiatal hernia, pyloric stenosis, peptic
ulcer, cholecystitis, large tumors in the ulcer, cholecystitis, large tumors in the abdomen, ascites, pregnancy, after abdomen, ascites, pregnancy, after gastrectomy, scleroderma, and other gastrectomy, scleroderma, and other diseases diseases
III. Severity (endoscopic classification of III. Severity (endoscopic classification of Savary and Miller, 1978)Savary and Miller, 1978)
Stages of cardiospasmStages of cardiospasm(B.V. Petrovsky)(B.V. Petrovsky)
Stages of cardiospasmStages of cardiospasm(B.V. Petrovsky)(B.V. Petrovsky)
Stage IStage I - unstable functional spasm of - unstable functional spasm of the cardia, the expansion of the the cardia, the expansion of the esophagus is not observed esophagus is not observed
Stage IIStage II - stable spasm of the cardia with - stable spasm of the cardia with soft extension of the esophagus soft extension of the esophagus
Stage IIIStage III - scarring the muscle layers of - scarring the muscle layers of the cardia with a pronounced expansion the cardia with a pronounced expansion of the esophagus of the esophagus
Stage IVStage IV - pronounced stenosis of the - pronounced stenosis of the cardia with dilation of the esophagus, cardia with dilation of the esophagus, often S-shaped with esophagitisoften S-shaped with esophagitis
CardiospasmCardiospasmCardiospasmCardiospasm
stage II stage III
stage IV
Treatment of the Treatment of the cardiospasmcardiospasm
Treatment of the cardiospasmcardiospasm
operation of Nissen
Achalasia of the Achalasia of the esophagusesophagus
The most characteristic The most characteristic symptoms of achalasia of the symptoms of achalasia of the
esophagusesophagus
The most characteristic The most characteristic symptoms of achalasia of the symptoms of achalasia of the
esophagusesophagus1.1. Dysphagia Dysphagia 2.2. After the passage of food techniques After the passage of food techniques
that increase the intraluminal pressure that increase the intraluminal pressure 3.3. Regurgitation (a few hours after a meal Regurgitation (a few hours after a meal
the night immediately after a meal) the night immediately after a meal) 4.4. Pain (pain crises, non-food, pain on Pain (pain crises, non-food, pain on
swallowing, paresthesias, itching, etc.) swallowing, paresthesias, itching, etc.) 5.5. Nausea, vomiting, weight loss Nausea, vomiting, weight loss 6.6. Complications (esophagitis, the Complications (esophagitis, the
transition to cancer, respiratory transition to cancer, respiratory disorders)disorders)
A benign tumor of the A benign tumor of the esophagusesophagus
A benign tumor of the A benign tumor of the esophagusesophagus
Removal of a benign tumor of Removal of a benign tumor of the esophagusthe esophagus
Removal of a benign tumor of Removal of a benign tumor of the esophagusthe esophagus
Cancer of the esophagusCancer of the esophagusCancer of the esophagusCancer of the esophagus
The share of esophageal cancer:
structure bowel diseases - 5-7%;
in the structure of all neoplasms of the body - 1.5-2%.
Mortality from cancer of the esophagus, in a number of other malignancies,
up - 5-6%.
Factors contributing to the development of cancer of the esophagus
Alcohol and tobacco; Deficiency of vitamin A, riboflavin, zinc, molybdenum; Dietary carcinogens; Chemical burns or stricture of the esophagus; Tyloses (a disease characterized by hyperkeratosis of the
palms and soles); Plummer-Vinson syndrome (iron deficiency anemia + +
achlorhydria stricture of the upper esophagus; A long-term untreated achalasia; Prior exposure of the mediastinum; Celiac disease and chronic non refluks esophagitis.
Cancer of the middle third of Cancer of the middle third of the esophagusthe esophagus
Cancer of the middle third of Cancer of the middle third of the esophagusthe esophagus
Cancer lower third of the Cancer lower third of the esophagusesophagus
Cancer lower third of the Cancer lower third of the esophagusesophagus
Growth form of esophageal Growth form of esophageal cancercancer
Growth form of esophageal Growth form of esophageal cancercancer
Symptoms of esophageal Symptoms of esophageal cancercancer
Symptoms of esophageal Symptoms of esophageal cancercancer
General General adynamy, weight loss, fatigue, low-grade fever, adynamy, weight loss, fatigue, low-grade fever,
hypoproteinemia hypoproteinemia
Characteristic of diseases of the chest Characteristic of diseases of the chest cavity cavity
blunt chest pain, tachycardia after eating, blunt chest pain, tachycardia after eating, changing the tone of voice, coughing changing the tone of voice, coughing
Characteristic of esophageal Characteristic of esophageal Dysphagia - reflex, mechanical or mixed, Dysphagia - reflex, mechanical or mixed,
increased salivation, pain, bad breath, bad increased salivation, pain, bad breath, bad taste, regurgitationtaste, regurgitation
Clinical manifestations of esophageal cancer
Dysphagia; Weight loss; Odynophagia; Constant chest pain, epigastric and back; Hiccups; Hypersalivation; Hoarseness; Symptoms of damage to the nervous system and
muscles; Vomiting blood.
Diagnosis primary binding studies
Chest X-ray in 2 projections; Polypositional contrast study of the esophagus and
stomach; Esophagoscopy with multiple biopsies from both the
tumor and from the mucosal sites are not altered by the expected resection line;
Morphological examination of the biopsy specimen; Ultrasound imaging of the mediastinum, supraclavicular
areas, abdominal, retroperitoneal, pelvic organs; ECG; bronchoscopy; General analysis of blood and urine tests, biochemical
blood tests, coagulation, immunoassay, blood group and Rh factor.
Diagnosis additional studies
Computed tomography of the chest and abdomen with contrast;
Diagnostic thoracoscopy; Diagnostic laparoscopy -with suspect
the presence of metastases in the abdominal cavity.
Radiographs of patients with Radiographs of patients with esophageal canceresophageal cancer
At the level of Th6 determined by restriction esophagus. Patency of barium significantly impeded. CONCLUSION: Cancer middle third of the esophagus.
There is a circular narrowing of the esophagus at the level of TH7, for 3.0-3.5 cm. Above which the esophagus suprastenoticheski expanded. CONCLUSION: Cancer between the middle and lower third of the esophagus (endophytic growth).
Radiographs of patients with Radiographs of patients with esophageal canceresophageal cancer
Esophagus pass all over. At the level of VTh6-Th7 determined luminal narrowing, tuberosity contours. The length of the process = 7.0-8.0 cm. CONCLUSION: Cancer middle third of the esophagus.
From the level of VTh V-VII, for 7.0-8.0 cm. Celebrated circular narrowing of the esophagus with irregular contours, the destruction of the mucous relief. CONCLUSION: Cancer middle third of the esophagus.
The differential diagnosis
Cardiospasm. Cicatricial narrowing of the esophagus. Esophageal ulcers and ulcerative esophagitis. Benign tumors of the esophagus. Esophageal varices. Diverticula of the esophagus. Compression of the esophagus from the outside tumors of the
mediastinum. Scars after suffering mediastinitis. Abnormally positioned vessels in the mediastinum.
Leading in the differential diagnosis of esophageal cancer is morphologically !!!
Only multiple negative answer, along with watchful waiting may make relatively favorable judgment.
Methods of treatment of esophageal cancer
radiation Herbal Surgical Combined Complex
Subtotal esophagectomy with intrapleural
simultaneous plasticity with stomach by Lewis.
Operation - one-step, two available.
Access - wide upper midline laparotomy bypassing the navel to the left, then anterolateral thoracotomy in the IV-V intercostal space on
the right.
Esophagogastroanastomosis in the right pleural cavity.