De Simone M, Cioffi U
Istituto di Chirurgia Generale e Toracopolmonare, Università degli Studi, Milano.
Minerva Chir. 1999 Jan-Feb;54(1-2):15-25.
Leiomyoma is the most common type of benign esophageal tumor, whereas extramucosal cysts of the esophagus are congenital anomalies frequently asymptomatic in the adult and in most cases detected incidentally on chest X-ray. Conventional imaging tests do not lead to a precise diagnosis. Endoscopic ultrasonography is very accurate in visualizing these lesions and in differentiating cystic from solid submucosal esophageal masses; in addition, the test can establish the exact location of the mass in relation to the esophageal wall and mediastinum.
Fifteen patients with esophageal leiomyoma and 27 patients with extramucosal esophageal cyst were operated on in our Institution. Dysphagia was the most common symptom in patients affected by leiomyoma and esophageal duplication cyst, whereas chest pain was more frequent in patients with bronchogenic cyst.
Complete surgical excision of the mass was performed in all patients with esophageal leiomyoma and in 26 patients with mediastinal cyst, while a right upper pulmonary lobectomy was performed in the patient with an intrapulmonary cyst.
Endoscopic ultrasonography plays an important role in the differential diagnosis of leiomyoma and mediastinal cyst. Surgery is mandatory in all patients especially after the advent of the mini-invasive procedures. Observation alone must be reserved for patients who refuse or are not suitable for thoracic surgery.
平滑肌瘤是最常见的食管良性肿瘤类型，而食管外膜囊肿是先天性异常，在成年人中通常无症状，多数情况下是在胸部X线检查时偶然发现。传统影像学检查无法做出精确诊断。内镜超声检查在观察这些病变以及区分囊性与实性食管黏膜下肿物方面非常准确；此外，该检查能够确定肿物相对于食管壁和纵隔的确切位置。
我们机构对15例食管平滑肌瘤患者和27例食管外膜囊肿患者进行了手术。吞咽困难是平滑肌瘤和食管重复囊肿患者最常见的症状，而胸痛在支气管源性囊肿患者中更为常见。
所有食管平滑肌瘤患者以及26例纵隔囊肿患者均进行了肿物的完整手术切除，而对1例肺内囊肿患者进行了右上肺叶切除术。
内镜超声检查在平滑肌瘤和纵隔囊肿的鉴别诊断中发挥着重要作用。对所有患者而言手术是必需的，尤其是在微创技术出现之后。对于拒绝或不适合胸外科手术的患者，只能选择单纯观察。
