Rzayev R.M. Рак гортаноглотки -IV стадия (T4NoMo) (I часть)

Rzayev R.M. Hypopharyngeal Cancer, IV stage. A 35-year-old female has been found out squamous-cell carcinoma hypopharynx IV stages without signs metastasis to regional lymph nodes at the moment of inspection. At endoscopy larynx presence of a hilly tumor located in retroarytenoid areas with signs involving it in left pyriform sinus is the patient it is made extended larygectomy with a circular resection laryngopharynx, cervical part of oesophagus and subtotal thyroidectomy. Operation included total removal larynx with laryngopharynx, a part of oropharynx, cervical part of oesophagus and left lobe a thyroid. Presence lesions distale part especially external wall pyriphorm sinus at the left was the indication for removal lobe a thyroid gland in this case. A year ago concerning the given disease it has been made bio - and then chymo - and radiotherapy; then was it is made tracheotomy and it is imposed gastrostoma. Feature of a cancer laryngopharynx is high aggression, fast infiltration growth with involving in process of associates organs and tissues, rather short period from occurrence of the first symptoms of disease before transition diseases in late forms. Our supervision in it the relation did not make an exception. At the given stage of operation mobilization laryngopharynx and cervical part of esophagus which are separated from prevertebral fascia is shown. Thus it is necessary to give special attention to that pharyngeal tensor muscles were separated together with it. Considering that ivolving cervical part of esophagus reached tumours about 1,5 sm to make a resection thus it was required to level of 1st thorax vertebral. A usually maximum separated trachea in this case allows to mobilize sufficiently esophagus. So, having tightened a trachea up after separated it from associate’s tissues, it is made separated esophagus using swab and a finger. It has allowed maximal to extend it in an operational wound. Usually esophagus it is possible to mobilize to 3rd thorax a vertebra. At a following stage of operation the section and ligation upper neurovascular plexus larynx is made separated. At the same time after separation left lobe a thyroid gland from cervical tissue and crossings of thyroid arteries it is made subtotal thyroidectomy. Further after separation larynx and laryngopharynx on sideways, mouth floor muscles are cut from a hypoglossal bone. It is known law according to which malignant tumors laryngopharynx on the aggression possess high frequency metastasis in regional lymph nodes, especially in upper to third of neck to preangular inclusive. For revealing regional metastasis’s, including metastasis’s in paratracheal nodes, necessary is interoperation inspection these zones. After a section esophagus all preparation will move up. Далее произведено вскрытие pharynx в области thyroid-sublingual мембраны справа. At separation specimen it is necessary to examine carefully it that it will be convinced in ablastic operations. Here it is visible, that the hilly tumor occupying upper part retroarytenoid areas extends on larynx. The tumor with side larynx occupies between arytenoids space and on arytenoids-epiglottis to folds reaches to larynx surfaces epiglottis, occupies a threshold larynx in the form of an original ring. Specimen it is cut from above, about 3 sm from tumor edge. Here it is necessary to notice, that because of massive lesions cervical part esophagus in this case was not possible to define a starting point of growth of a tumor. After lavage a wound it is closed by antibiotics, imposing on vertebral skin flaps. The last are stitched to peryvertebral fascia. Upper level wounds it is formed pharyngostoma. Stitching stump esophagus to a skin over tracheostomy it is formed esophagostoma. Between esophago - and tracheostomy it is created skin straight arch which is necessary for plastic restoration digestive tubes further.