Terayama Masayoshi, Kumagai Koshi, Kawachi Hiroshi, Makuuchi Rie, Hayami Masaru, Ida Satoshi, Ohashi Manabu, Sano Takeshi, Nunobe Souya
Department of Gastroenterological Surgery, Gastroenterological Center, Cancer Institute Hospital, Japanese Foundation for Cancer Research, Tokyo 135-8550, Japan.
Department of Pathology, Cancer Institute Hospital, Japanese Foundation for Cancer Research, Tokyo 135-8550, Japan.
World J Gastrointest Surg. 2023 Jun 27;15(6):1216-1223. doi: 10.4240/wjgs.v15.i6.1216.
Bronchogenic cysts are congenital lesions requiring radical resection because of malignant potential. However, a method for the optimal resection of these cysts has not been completely elucidated.
Herein, we presented three patients with bronchogenic cysts that were located adjacent to the gastric wall and resected laparoscopically. The cysts were detected incidentally with no symptoms and the preoperative diagnosis was challenging to obtain radiological examinations. Based on laparoscopic findings, the cyst was attached firmly to the gastric wall and the boundary between the gastric and cyst walls was difficult to identify. Consequently, resection of cysts alone caused cystic wall injury in Patient 1. Meanwhile, the cyst was resected completely along with a part of the gastric wall in Patient 2. Histopathological examination revealed the final diagnosis of bronchogenic cyst and revealed that the cyst wall shared the muscular layer with the gastric wall in Patients 1 and 2. In Patient 3, the cyst was located adjacent to the gastric wall but histopathologically originated from diaphragm rather than stomach. All the patients were free from recurrence.
The findings of this study state that a safe and complete resection of bronchogenic cysts required the adherent gastric muscular layer or full-thickness dissection, if bronchogenic cysts are suspected pre- and/or intraoperative findings.
支气管源性囊肿是先天性病变，因其具有恶变潜能而需要根治性切除。然而，这些囊肿的最佳切除方法尚未完全阐明。
在此，我们报告了3例支气管源性囊肿患者，囊肿位于胃壁附近，通过腹腔镜进行了切除。这些囊肿是偶然发现的，没有症状，术前通过影像学检查难以获得诊断。根据腹腔镜检查结果，囊肿与胃壁紧密相连，胃壁与囊肿壁之间的边界难以辨认。因此，在患者1中单独切除囊肿导致了囊肿壁损伤。同时，在患者2中，囊肿与部分胃壁一起被完整切除。组织病理学检查最终确诊为支气管源性囊肿，并显示患者1和患者2的囊肿壁与胃壁共享肌层。在患者3中，囊肿位于胃壁附近，但组织病理学检查显示其起源于膈肌而非胃。所有患者均无复发。
本研究结果表明，如果术前和/或术中发现疑似支气管源性囊肿，安全完整地切除囊肿需要切除附着的胃肌层或进行全层剥离。
