Department of Gastroenterology, The Second Xiangya Hospital of Central South University.
Department of Cardiovascular Medicine, The Second Xiangya Hospital of Central South University.
Rev Esp Enferm Dig. 2019 Sep;111(9):710-711. doi: 10.17235/reed.2019.5750/2018.
A 50-year-old female came to our hospital with a 6-month history of upper abdominal discomfort. An upper endoscopy detected a protruding lesion that measured 3.0×2.0 cm at around 35-38 cm from the incisors located on the posterior wall. Endoscopic ultrasonography revealed a homogeneous hyperechoic mass located in the muscularis propria, with no malignant features. Contrast-enhanced CT was also performed. A submucosal tunneling endoscopic resection (STER) was performed. A longitudinal mucosal incision was made and a submucosal tunnel created, which uncovered an irregularly giant tumor. The size of the resected tumor was 3.0×4.0×1.5cm and the histopathological analysis identified leiomyomas. The patient was discharged 7 days after the procedure and 3 months after the surgery there was no recurrence on the CT scan. Meanwhile, the discomfort of the patient was relieved after STER and there were no severe complications during the 6-month follow-up. DISCUSSION Esophageal leiomyoma is a benign submucosal tumor derived from the muscularis propria layer of the esophagus [1]. STER has been demonstrated to be safe and effective for treating small (≤3.5 cm) and solitary esophageal leiomyoma with low complication rates [2-3]. Most esophageal leiomyoma grow into the lumen and their positions in the tunnel are relatively superficial and the entire surgery is comparatively safe. In this case, the tumor was very large and was close to the mediastinum, which greatly increases the difficulty of surgery. However, STER is recommended according to our experience, even in rare cases.
一位 50 岁女性因上腹部不适来我院就诊，病程 6 个月。上消化道内镜检查发现一突出病变，位于切牙后 35-38cm 的后壁，大小约为 3.0×2.0cm。内镜超声检查显示固有肌层内存在均质高回声肿块，无恶性特征。增强 CT 也进行了检查。进行了黏膜下隧道内镜切除术（STER）。进行了纵向黏膜切口，并创建了黏膜下隧道，揭示了一个不规则的巨大肿瘤。切除的肿瘤大小为 3.0×4.0×1.5cm，组织病理学分析确定为平滑肌瘤。患者在手术后 7 天出院，术后 3 个月 CT 扫描未见复发。同时，STER 缓解了患者的不适，在 6 个月的随访中没有出现严重并发症。讨论食管平滑肌瘤是一种良性黏膜下肿瘤，来源于食管固有肌层[1]。STER 已被证明是治疗小（≤3.5cm）和单发食管平滑肌瘤的安全有效方法，并发症发生率低[2-3]。大多数食管平滑肌瘤向管腔生长，其隧道内位置相对较浅，整个手术相对安全。在这种情况下，肿瘤非常大，且靠近纵隔，大大增加了手术难度。然而，根据我们的经验，即使在罕见情况下，也推荐使用 STER。
