食管平滑肌瘤的诊断和手术治疗的特点

Diagnosis and surgical treatment of 26 cases of esophageal leiomyoma

目的总结食管平滑肌瘤的临床诊断和外科手术治疗特点。方法对26例诊断为食管平滑肌瘤患者的临床症状、术前影像学、纤维食管镜检查资料及外科治疗结果进行回顾性分析。结果本组无手术死亡及食管瘘,术后并发肺部感染2例(7.7)%,其余病例顺利恢复。结论术前综合应用CT、食管腔内超声等检查手段可提高诊断食管平滑肌瘤的准确率。黏膜外平滑肌瘤摘除术仍是最常用的术式。食管部分切除术只适用于肿瘤巨大或合并食管恶性病变病例。

Objective To summarize the characteristics of diagnosis and surgical treatment of esophageal leiomyoma. Methods The data of radiology, esophagoscopy and results of surgical treatment were retrospectively analyzed in total 26 patients with esophageal leiomyoma diagnosed preoperatively. Results Dysphagia （76. 9% ） and chest or epigastric pain （42.3%） were the most common presenting symptoms with a mean duration of 14.3 months. Twenty-one patients were treated with tumor removal only, among which the esophageal mucosa was ruptured and sutured in 7 patients and 3 patients were diagnosed as malignant esophageal disease or mediastinal tumor in the operation. Four patients received partial esophageal resection, including 2 patients with gigantic tumor. The tumor was single in all the patients who diagnosed as esophageal leiomyoma. There were no death during operation. The most frequent perioperative complications were pulmonary infection with occurrence rate of 7.7%. Conclusion The use of CT and transesophageal endo-luminal uhrasonography do help to establish the diagnosis of esophageal leiomyoma. Tumor removal only is still a standard surgical treatment for esophageal leiomyoma, the key point of which is to keep the esophageal mucosa intact. Partial esophageal resection is performed when the diagnosis is malignant esophageal disease or gigantic tumor.