Jiang G, Zhao H, Yang F, Li J, Li Y, Liu Y, Liu J, Wang J
Department of Thoracic Surgery, Center for Mini-invasive Thoracic Surgery, People's Hospital, Peking University, Beijing, China.
Dis Esophagus. 2009;22(3):279-83. doi: 10.1111/j.1442-2050.2008.00883.x. Epub 2008 Nov 19.
Esophageal leiomyoma is the most common benign esophageal tumor. Thoracoscopic enucleation is currently a preferred approach to most of these lesions. We present our experiences of enucleation of these tumors using thoracoscopic approach. A retrospective review of 40 patients who underwent enucleation of esophageal leiomyoma from 1997 to 2007 in our institute was conducted. Presenting symptoms, operative approach, tumor size, tumor shape, outcomes, and indication for this approach were analyzed. Forty patients were identified. Postoperative histopathology confirmed the leiomyoma in all patients. The thoracoscopic enucleation was completed in 34 cases, and the operation was converted to open procedure in six cases. Reasons for conversion included too small tumors to be visualized in two cases, thoracic cavity adhesion in one case, and the too large tumors in three cases. The median operating time was 70 min (50 to 210 min). Mean tumor size was 3.7 cm (0.5-10 cm). There were no major postoperative complications. Symptoms especially dysphasia were relieved postoperatively. Short- and long-term follow-up was satisfactory with none of the patients having tumor recurrences or other problems. Thoracoscopic enucleation of esophageal leiomyoma is technically safe and effective. It is currently the best choice for management of esophageal leiomyoma 1 to 5 cm in diameter. It can also be tried on a tumor larger than 5 cm, although the possibility of conversion to thoracotomy increases along with tumor growing and surrounding the esophagus.
食管平滑肌瘤是最常见的食管良性肿瘤。胸腔镜摘除术是目前处理大多数此类病变的首选方法。我们介绍了使用胸腔镜方法摘除这些肿瘤的经验。对1997年至2007年在我院接受食管平滑肌瘤摘除术的40例患者进行了回顾性研究。分析了患者的临床表现、手术方式、肿瘤大小、肿瘤形态、手术结果及该手术方式的适应证。共纳入40例患者。术后组织病理学检查证实所有患者均为平滑肌瘤。34例患者成功完成胸腔镜摘除术，6例中转开胸手术。中转原因包括2例肿瘤过小难以看清，1例胸腔粘连，3例肿瘤过大。中位手术时间为70分钟（50至210分钟）。平均肿瘤大小为3.7厘米（0.5 - 10厘米）。术后无严重并发症。术后症状尤其是吞咽困难得到缓解。短期和长期随访结果满意，所有患者均无肿瘤复发或其他问题。胸腔镜下食管平滑肌瘤摘除术在技术上是安全有效的。它是目前直径1至5厘米食管平滑肌瘤治疗的最佳选择。对于大于5厘米的肿瘤也可尝试，但随着肿瘤增大并包绕食管，中转开胸的可能性增加。
