胸腔镜下食管平滑肌瘤摘除术39例

Video-assisted thoracoscopic surgery in the treatment of esophageal leiomyoma：a report of 39 cases

目的探讨胸腔镜下食管平滑肌瘤摘除术的可行性和有效性。方法回顾分析2002年12月至2008年11月共计39例食管平滑肌瘤胸腔镜手术患者的临床资料。结果36例患者经右侧进胸．3例经左侧进胸：胸腔镜下完成手术者38例，1例术中发生食管黏膜破裂，予以开胸行食管黏膜修补术。手术时间1～5（1．2±0．6）h；术中出血30～100（50±8．3）ml。肿瘤最大横径0．8～6．0（3．0±0．7）cm。术后胸管拔出时间为1～4（1．5±0．7）d：胸腔引流量为100～500（200±101）ml。除1例术中食管黏膜破裂行食管黏膜修补术．余患者无手术并发症和死亡发生。术后住院时间3-10（3．6±1．2）d。术后随访1个月至6年。所有患者未见肿瘤复发，无不适症状。结论胸腔镜下食管平滑肌瘤切除术安全可行．是治疗食管平滑肌瘤的主要手术方式之一。

Objective To investigate the application and efficacy of video-assisted thoracoscopic surgery in the treatment of esophageal leiomyoma. Methods Clinical data of 39 patients with esophageal leiomyoma from December 2002 to November 2008 treated by video-assisted thoracoscopic surgery were reviewed retrospectively. Results Video-assisted thoracoseopic leiomyoma enucleations were performed in 38 patients, and one patient was converted to thoracotomy to repair the esophageal mueosa because of mucosa rupture during the operation. Thirty-six patients were treated through the right chest and the other 3 cases through the left. The operation time ranged from 1 to 5 （1.2±0.6） h. The blood loss ranged from 30 to 100（50±8.3） ml. The time of chest tube placement ranged from 1 to 4 （1.5±0.7） d. The drainage amount was 100 to 500（200±101） ml. The hospital stay ranged from 3 to 10 （3.6±1.2） d. The maximal diameter of the tumor ranged from 0.8 to 6.0 （3.0±0.7） cm. There were no surgery-related complications or deaths except the case with esophageal mueosa rupture. There were no uncomfortable complains and tumor recurrence within the follow-up period of 1 to 72 months after operation. Conclusion Video-assisted thoracoscopic leiomyoma enucleation is a safe and effective approach for esophageal leiomyoma.