[Application of isolation traction of aortic arch and upper part of the thoracic aorta in operation on cancer of the esophagus]

Isolation traction of aortic arch and upper part of thoracic aorta was performed by pulling and rotating them rightwards during operation on cancer located in the mid-segment of esophagus with serious adhesions. In 35 patients operated on, 33 cancers were resected with resection rate of 94%, including 21 by radical resection (60%) and 12 by palliative operation (34%). The method was to isolate the aortic arch and the upper part of thoracic aorta sufficiently and ligate the severed intercostal arteries and veins securely. While isolating the aorta, we pulled and rotated it with a strip of bandage and exerted strength evenly and gently as long as the operation field was exposed clearly. Otherwise, the heart function may be compromised. When isolating the aorta, a slight drop of blood pressure could be observed in some cases. It could recover immediately as we stop pulling and replaced the aorta in situ. According to our clinical experience, its advantages were: 1. It can prevent and treat the bleeding of hemiazygos vein. None of the 33 patients with adhesion and infiltration between the tumor and hemiazygos vein bled during the operation, even with the hemiazygos vein torn and bleeding. Bleeding could be stopped with ease because of good exposure; 2. It can extend the limit of resection and raise the resection rate; 3. It can broaden the space between the aorta and esophagus which is convenient for esophagogastrostomy on the esophagus bed, and 4. It can secure ligation of thoracic duct to prevent chylothorax.

A prospective study of esophageal cytological atypia in Linxian county

Between 1975 and 1986, in Linxian county (LX), a prospective study of esophageal cytological hyperplasia and atypia was conducted on 3 groups of subjects: 294 with marked atypia, 328 with mild hyperplasia and 336 normal controls; all were diagnosed by cytology. Results showed that no significant difference in incidence of esophageal cancer (EC) appeared between subjects with mild hyperplasia and controls, while the incidence of EC in subjects with marked atypia was 1,178.92/100,000 which was 2.39 (after age-adjustment 2.90) times higher than that found in the control group and was of statistical significance (chi 2 = 8.92, p less than 0.01). In all groups, the relatively high risk of contracting EC was closely associated with drinking ground water, smoking and a low standard of living. These results suggest that early treatment should be given to subjects with marked atypia, accompanied by preventive measures against carcinoma of the esophagus, such as hygienic drinking water, abstention from smoking and better living conditions.