COMPUTED TOMOGRAPHIC ANATOMY OF THE MEDIASTINUM IN NORM, IN ESOPHAGEAL CANCER AND AFTER RESECTION OF THORACIC ESOPHAGUS WITH AUTOGASTROPLASTY

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Aim. Comparison of topographic and anatomical parameters of the mediastinum and its organs in norm and after resection of the thoracic esophagus with plastic gastric graft. Material and Methods. The material of the anatomical section of the study was the in vivo computed tomograms of the thorax of 115 patients who had no digestive pathology, and 40 patients examined and operated in the Orenburg cancer clinic with a diagnosis of breast cancer of the esophagus. The paper uses the following methods: computed tomography; morphometry and variation-statistical processing of the data. Results and Discussion. The average values of the anterior-posterior size of the mediastinum increased from 54.8±0.7 mm at the level of the sternoclavicular articulation to of 129.7±2.0 mm at the level of the base of the heart, the transverse dimension of anterior mediastinum, respectively, of a 60.3±1.4 to 102.0±2.5 mm, the transverse dimension of the posterior mediastinum from 21.7±1.4 to 32.8±1.4 mm. When cancer of the thoracic esophagus is the displacement of the heart anterior and left with an approach to the anterior thoracic wall to an average of 4.8 mm, the trachea and the left main bronchus anteriorly, the descending part of the thoracic aorta to the left and posteriorly with the movement of the lateral surface of the vertebral bodies. After resection of the esophagus with autogastroplasty due to the movement of the posterior mediastinum of the gastric graft, in the first two weeks after the operation, there is a decrease in the anterior dimension of the mediastinum, an increase in the transverse size of the posterior mediastinum with its displacement to the right of the median plane, preserving the displacement of the heart forward to the sternum, and the thoracic aorta to the left on the lateral surface of the vertebral bodies. By three months, the gastric graft occupies the position of the esophagus in the posterior mediastinum, the mediastinum parameters return to the preoperative parameters and remainin the long term. Conclusions. In the course of the study, new in vivo data on computer tomographic anatomy and topography of the mediastinum and its organs were obtained.