Ishii Mitsutoshi, Takeno Shinsuke, Nishida Takahiro, Nanashima Atsushi, Kubota Yoshimasa, Kawakami Hiroshi, Umekita Yoshiko, Akiyama Yutaka
Division of Gastrointestinal, Endocrine and Pediatric Surgery in the Department of Surgery, Faculty of Medicine, University of Miyazaki.
Division of Gastrointestinal, Endocrine and Pediatric Surgery in the Department of Surgery, Faculty of Medicine, University of Miyazaki; Division of Endoscopy, University of Miyazaki Hospital.
Int J Surg Case Rep. 2017;34:49-55. doi: 10.1016/j.ijscr.2017.03.007. Epub 2017 Mar 8.
We report a relatively rare case of esophageal leiomyoma in the upper thoracic esophagus enucleated by thoracoscopic procedures. The usefulness of preoperative diagnosis and an adequate surgical approach are described along with a review of the relevant literature.
A submucosal tumor 45mm in diameter was detected in the upper thoracic esophagus of a 69-year-old man. The tumor was preoperatively diagnosed from histopathological biopsy under endoscopic ultrasound-guided fine needle aspiration. Thoracoscopic enucleation was therefore preoperatively scheduled under the left decubitus position in consideration of the low risk of malignant disease. Histopathological diagnosis of the resected specimen was benign leiomyoma and patient outcomes were good.
The need for preoperative biopsy of esophageal submucosal tumor is a controversial issue. However, preoperative biopsy provided the benefits to decide the operative procedure or confirm adequate resection, and our experience suggested that preoperative biopsy did not adversely influence subsequent enucleation.
Precise preoperative diagnosis is necessary to avoid excessive surgery when managing esophageal submucosal tumor.
我们报告了一例相对罕见的上胸段食管平滑肌瘤，通过胸腔镜手术摘除。本文描述了术前诊断的作用和适当的手术方法，并对相关文献进行了综述。
一名69岁男性的上胸段食管发现一个直径45mm的黏膜下肿瘤。术前通过内镜超声引导下细针穿刺活检进行组织病理学诊断。考虑到恶性疾病风险较低，因此术前计划在左侧卧位下行胸腔镜摘除术。切除标本的组织病理学诊断为良性平滑肌瘤，患者预后良好。
食管黏膜下肿瘤术前活检的必要性是一个有争议的问题。然而，术前活检有助于决定手术方式或确认切除是否充分，我们的经验表明术前活检不会对后续摘除术产生不利影响。
在处理食管黏膜下肿瘤时，精确的术前诊断对于避免过度手术是必要的。
