Smooth muscle tumours of the alimentary tract.

Neoplasms arising from smooth muscle of the gastrointestinal (GI) tract are uncommon, comprising only 1% of gastrointestinal tumours. A total of 51 cases of smooth muscle tumour of the GI tract were analysed; 44 leiomyomas and 7 leiomyosarcomas. Lesions occurred in all areas from the oesophagus to the rectum, the stomach being the commonest site. Thirty-six patients had clinical features referable to the tumour. The tumour was detected during investigation or management of an unrelated disease process in 15 patients. The clinical presentation varied depending on tumour location, but abdominal pain and GI bleeding were the commonest presenting symptoms. The lesion was demonstrated preoperatively, mainly by endoscopy and barium studies, in 27 patients. Surgical excision was the treatment of choice, where possible. There was no recurrence in the leiomyoma group but four patients died in the leiomyosarcoma group. Although rare, smooth muscle tumours should be considered in situations where clinical presentation and investigations are not suggestive of any common GI disorder. The preoperative assessment and diagnosis is difficult because of the variability in clinical features and their inaccessibility to routine GI investigation. It is recommended that, where possible, the lesion, whether symptomatic or discovered incidentally, should be excised completely to achieve a cure and prevent future complications.     

Smooth muscle tumours of the upper gastrointestinal tract

Forty-six patients with smooth muscle tumours of the stomach and small intestine were treated surgically at the Princess Alexandra Hospital between 1970 and 1986. Leiomyomas were three times more common than leiomyosarcomas, but malignant tumours occurred more frequently in the small intestine than in the stomach. Gastric tumours tended to present with gastrointestinal bleeding, in contrast to intestinal lesions which presented predominantly with abdominal pain. Although leiomyomas tend to be smaller at operation than leiomyosarcomas, the size of a smooth muscle tumour is not reliable in discriminating between benign and malignant lesions. Therefore all smooth muscle tumours of the upper gastrointestinal tract should be excised as widely as possible, including local lymphatics in the dissection where practicable, so as to maximize the likelihood of radical extirpation of malignant lesions. Approximately one-third of patients with leiomyosarcomas have metastases at the time of surgery; the 5 year survival rate after surgical treatment of leiomyosarcomas of the upper gastrointestinal tract is less than 50%.     

Smooth muscle tumours of the digestive tract: report of 160 cases

Of 160 patients seen in the period 1951-84 with smooth muscle tumours of the digestive tract, 71 proved to have leiomyomas, 87 had leiomyosarcomas and 2 had leiomyoblastomas. Tumour diameter was frequently greater in patients with leiomyosarcoma. The surgical mortality was 2.8 per cent after treatment of leiomyoma and 10.3 per cent after treatment of leiomyosarcoma. After resection of leiomyosarcoma the 2-year survival rate was 86 per cent and the 5-year survival rate was 43 per cent. The only hope of cure of these malignant lesions lies in surgical resection but, even when the lesion is incurable, resection may allow worthwhile palliation.     

Smooth muscle tumours of the oesophagus

Twelve patients with oesophageal smooth muscle tumour were operated on between 1955 and 1984 in the Department of Thoracic and Cardiovascular Surgery of Helsinki University Central Hospital. Eleven tumours were leiomyomata, the twelfth was a leiomyosarcoma. Dysphagia (83%) and chest or epigastric pains (67%) were the most common symptoms presented. All patients underwent transthoracic removal of the tumour. Complications of the surgery included two cases of postoperative oesophageal fistula; in both instances the lumen of the oesophagus had been entered during the extirpation of the tumour. The surgery was effective in eliminating the most prominent symptom, i.e. dysphagia. However, follow-up examinations 11.1 +/- 6.8 (SD) years later revealed reflux symptoms and endoscopically and histologically verified oesophagitis in seven of the nine (78%) surviving patients. Additionally, two of them had developed Barrett's oesophagus, 10 and 19 years, respectively, after the primary surgery. These two patients underwent subsequent transabdominal antireflux procedures (Nissen fundoplication). We conclude that long-term follow-up of patients who have been treated for benign oesophageal tumour is indicated.     

胃肠道平滑肌肿瘤的诊断与治疗

目的 探讨胃肠道平滑肌肿瘤的诊断及治疗。方法 回顾性分析1982－1999年收治的92例胃肠道平滑肌肿瘤的的临床及病理资料。结果 发病部位：胃41例,小肠44例,结肠3例,直肠4例。良性肿瘤42例,恶性肿瘤50例。辅助检查：B超检查63例,阳性31例（49．2％）;CT检查27例,20例阳性（74．1％）;DSA检查29例,27例阳性（93．1％）;钡餐检查45例,阳性28例（62．2％）;小肠镜检查11例,2例阳性（18．2％）。ECT检查32例,20例阳性（62．5％）。结论 对胃肠道特别是小肠的平滑肌肿瘤,DSA检查是安全有效的理想方法。手术切除是治疗胃肠道平滑肌肿瘤的主要方法。     

Haemorrhage from smooth muscle tumours of the upper gastro-intestinal tract

Eight patients with haemorrhage from smooth muscle tumours of the upper gastro-intestinal tract were treated during a 10 year period from 1973 to 1982. Seven of the tumours were benign and one a malignant leiomyoblastoma. Seven tumours were sited in the stomach and there was one duodenal lesion. Endoscopy was performed in all eight cases and made the diagnosis definitively in four. In two cases the diagnosis was confirmed on barium meal and in the other two, diagnosis was eventually made at laparotomy. Two patients were shocked on admission and required emergency surgery. In one case a diameter greater than 10 cm suggested malignant potential and wide local resection was performed. In one other case with a tumour in the antrum, a distal partial gastrectomy was performed, and in the case with leiomyoblastoma a proximal gastrectomy was performed. One case was lost to follow-up. The mean follow-up in six cases free of disease with benign tumour was 2.6 years. The patient with a tumour of greater than 10 cm in diameter remains well at 18 months follow-up and the patient with a malignant leiomyoblastoma died 2 years after surgery.     

Direct inhibitory effect of erythromycin on human alimentary tract smooth muscle

BACKGROUND: Erythromycin was found to stimulate motor activity in the upper gastrointestinal tract. However, in several smooth muscle preparations, it also elicited an inhibitory effect. Our aim was to study the effect of erythromycin in various human alimentary tract smooth muscles. METHODS: Using force measurements, we assessed the effect of erythromycin on electrically and chemically evoked contractions of isolated muscle strips of human gallbladder, small intestine, and colon. RESULTS: The muscarinic receptor agonist carbachol evoked contraction in gallbladder, ileum, and colonic smooth muscle that were reduced by erythromycin at 10(-4) M to 72% +/- 24%, 77% +/- 22%, and 76% +/- 22% of control values, respectively. Erythromycin did not affect contractions evoked by noncholinergic agents. Erythromycin's inhibitory effects were not altered by nerve blockade, indicating a direct muscle effect. Eryrthromycin also reduced contractions evoked by electrical stimulation at frequencies of 5, 10, and 20 Hz in the human gallbladder, ileum, and colon preparations. These contractions were reduced by erythromycin in a reversible and dose-dependent manner. CONCLUSIONS: Erythromycin antagonized direct cholinergic effects on various smooth muscles from the human alimentary tract in a concentration-dependent manner.     

胃肠道血管瘤

１８例胃肠道血管瘤患者，１４例行手术治疗，２例直肠血管瘤行套扎术，均获得满意疗效。探讨了胃肠道血管瘤的分类、病因、病理、诊断、术前和术中寻找血管瘤病灶的方法及治疗。     

A triple duplication of the alimentary tract

Duplications of the alimentary tract occur infrequently, and are usually isolated anomalies. In the infant described below, a complex clinical picture was the result of three distinct duplication in widely separated portions of the alimentary tract (esophagus, duodenum, ileum). Details of the clinical course and technical management of an extremely long ileal duplication form the basis for this report.     

胰十二指肠切除术的消化道重建方式

胰十二指肠切除术(pancreaticoduodenectomy,PD)是治疗胰头癌及壶腹周围癌的经典术式。但由于手术时间长、涉及多个重要器官联合切除及消化道重建等诸多问题,术后易发生诸多并发症,其中最严重的并发症之一就是胰肠吻合口瘘(下称胰瘘)。据文献报道胰瘘发生率为5%～40%[1],由     

Surgery of the alimentary tract: An overview

An overview of surgery of the alimentary tract is presented in three parts. The first part is designed to give historical perspective, showing the relatively recent development of surgery of the alimentary tract compared with surgery of other systems. Three particularly important reasons for its slow development are medicolegal constraints, lack of educational materials and a high incidence of illiteracy among surgeons. Lessons to be learned include the following: (1) inappropriate legal constraints stifle progress; (2) mechanisms for prompt distribution of information are critical for rapid and steady progress; and (3) the distribution of knowledge does not insure its proper use.The second part on the present status of alimentary tract surgery discusses the development of specialty societies and particularly the Society for Surgery of the Alimentary Tract, noting that programs of this society have shown an increased percentage of papers devoted to animal and clinical experiments over the years.In the third section on the future of alimentary tract surgery, it is observed that among men in this country there are more abdominal operations per 1,000 persons than any other type of operation, despite the rapid increase in cardiovascular surgery and operations involving other organ systems. Presentations by previous presidents of the society have pointed out many challenging and fascinating areas of study. Thus for our generation and future generations of surgeons, the study and treatment of gastrointestinal disease makes surgery of the alimentary tract an exciting and challenging arena.