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首页> 外文期刊>Surgical Endoscopy >Minimally invasive enucleation of esophageal leiomyoma
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Minimally invasive enucleation of esophageal leiomyoma

机译：食管平滑肌瘤的微创摘除术

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Background: Leiomyoma accounts for 70% of all benign tumors of the esophagus. Open enucleation via thoracotomy has long been the standard procedure, but thoracoscopic and laparoscopic approaches have recently emerged as interesting alternatives. To date, only case reports or very small series of such techniques have been reported. The authors report their experience over the past decade. Methods: Between January 1999 and August 2005, 11 patients (6 men and 5 women; median age, 44 years) underwent surgery after presenting with dysphagia, chest pain, or heartburn. The surgical approaches included right video-assisted thoracoscopy (n = 7) for tumors of the middle lower third of the esophagus and laparoscopy (n = 4) for tumors within 4 to 5 cm of the lower esophageal sphincter or located at the gastroesophageal junction (GEJ). Intraoperative endoscopy with air insufflation during enucleation was used to confirm mucosal integrity and safeguard against esophageal perforation. Reapproximation of the muscle layers was performed after tumor enucleation to prevent the development of a pseudodiverticulum. A Nissen or Toupet fundoplication was added for patients undergoing laparoscopic enucleation of the leiomyoma. Results: The median operative time was 150 min. All tumors were benign leiomyomas (median size, 4.5 cm). One leiomyoma located at the gastroesophageal junction required intraoperative mucosal repair with three stitches for an esophageal perforation (preoperative biopsies had been taken). There were no major morbidities, including deaths or postoperative leaks. The median postoperative hospital stay was 6 days. All the patients were free of dysphagia during a median follow-up period of 27 months. One patient had a small (<2 cm) asymptomatic pseudodiverticulum at the 6-month follow-up endoscopy. Conclusions: Video-assisted enucleation of esophageal leiomyoma can be performed effectively and safely with no mortality and low morbidity. Thoracoscopic and laparoscopic techniques for the removal of esophageal leiomyomas may be recommended as the treatment of choice in centers experienced with minimally invasive surgery. 2006 Springer Science+Business Media, Inc.
机译：背景：平滑肌瘤占所有食道良性肿瘤的70％​​。长期以来，通过开胸切开术进行摘除术一直是标准方法，但最近已出现了胸腔镜和腹腔镜手术的替代方法。迄今为止，仅报道了病例报告或此类技术的极小系列。作者报告了他们过去十年的经验。方法：1999年1月至2005年8月，有11例患者（6例男性和5例女性;中位年龄为44岁）在出现吞咽困难，胸痛或胃灼热后接受了手术。手术方法包括对食管中下部下三分之一的肿瘤进行右胸腔镜检查（n = 7），对食管下括约肌4至5 cm内或位于胃食管连接处的肿瘤进行腹腔镜检查（n = 4）（ GEJ）。术中在摘除过程中进行气镜内窥镜检查以确认粘膜完整性并预防食道穿孔。肿瘤摘除后进行肌肉层的重新逼近，以防止假憩室的发展。腹腔镜摘除平滑肌瘤的患者增加了Nissen或Toupet胃底折叠术。结果：中位手术时间为150分钟。所有肿瘤均为良性平滑肌瘤（中位大小为4.5 cm）。一个位于胃食管连接处的平滑肌瘤需要术中粘膜修复，并需缝合三针以进行食管穿孔（已进行术前活检）。没有大的发病率，包括死亡或术后渗漏。术后中位住院时间为6天。在27个月的中位随访期内，所有患者均无吞咽困难。在6个月的随访内镜检查中，一名患者有一个小的（<2 cm）无症状假憩室。结论：视频辅助摘除食管平滑肌瘤可以安全有效地进行，无致死率和低发病率。在有微创手术经验的中心，可能建议采用胸腔镜和腹腔镜技术去除食管平滑肌瘤。 2006年Springer Science + Business Media，Inc.

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