Choi S H, Kim Y T, Han K N, Ra Y J, Kang C H, Sung S W, Kim J H
Department of Thoracic and Cardiovascular Surgery, Clinical Research Institute, Seoul National University Hospital, SeoulCancer Research Institute, The Transplantation Research Center, Seoul National University College of Medicine, SeoulDepartment of Thoracic and Cardiovascular Surgery, Busan National University Yangsan Hospital, Busan, Republic of Korea.
Dis Esophagus. 2011 Jul;24(5):325-9. doi: 10.1111/j.1442-2050.2010.01144.x. Epub 2010 Dec 10.
Esophageal leiomyoma is the most common benign tumor of the esophagus. Although enucleation via thoracotomy has been considered standard treatment, minimally invasive surgery is increasingly used for the treatment of this disease. We analyzed our surgical outcomes by comparing thoracotomy and the thoracoscopic approach. A retrospective review was performed of patients who underwent surgical resection of esophageal leiomyomas at the Seoul National University Hospital. Between 1982 and 2005, 63 patients were identified (male, n= 39; female, n= 24) at a mean age of 44.5 years. Thirty-two patients (51%) were symptomatic. Forty-five patients underwent thoracotomy, and 18 patients were resected using thoracoscopy. There was no mortality. The mean length of hospital stay was 10.3 days in the open group and 8.0 days in thoracoscopy group. Intraoperative mucosal repair was required in eight patients. Preoperative endoscopic mucosal biopsy within 1 month was identified as a risk factor for mucosal injury. Among the 11 patients with tumors less than 1.5 cm in size, thoracoscopic resection was attempted on four patients, and three out of the four cases required conversions to thoracotomy. Minimally invasive surgery for esophageal leiomyoma can be performed with good results. Our results suggest that the thoracoscopic approach should be considered as a standard surgical method for the treatment of esophageal leiomyoma. However, in cases of small tumors less than 1.5 cm in size, localization of the tumor may be difficult, and if asymptomatic, a regular monitoring should be considered as an alternative approach in such small tumors.
食管平滑肌瘤是食管最常见的良性肿瘤。尽管经胸壁切开摘除术一直被视为标准治疗方法，但微创手术越来越多地用于治疗这种疾病。我们通过比较开胸手术和胸腔镜手术方法分析了手术结果。对在首尔国立大学医院接受食管平滑肌瘤手术切除的患者进行了回顾性研究。1982年至2005年间，共确定63例患者（男性39例，女性24例），平均年龄44.5岁。32例患者（51%）有症状。45例患者接受了开胸手术，18例患者采用胸腔镜切除。无死亡病例。开胸组平均住院时间为10.3天，胸腔镜组为8.0天。8例患者术中需要进行黏膜修复。术前1个月内进行内镜黏膜活检被确定为黏膜损伤的危险因素。在11例肿瘤大小小于1.5 cm的患者中，4例尝试进行胸腔镜切除，其中3例需要转为开胸手术。食管平滑肌瘤的微创手术可以取得良好效果。我们的结果表明，胸腔镜手术方法应被视为治疗食管平滑肌瘤的标准手术方法。然而，对于小于1.5 cm的小肿瘤，肿瘤定位可能困难，如果无症状，对于此类小肿瘤可考虑定期监测作为替代方法。
