食管平滑肌瘤的外科治疗(附32例报告)

目的:探讨食管平滑肌瘤的诊断、治疗方法及其疗效。方法:分析手术治疗32例食管平滑肌瘤的临床资料。结果:单发型30例,多发型2例。肿瘤位于食管上段2例,中段27例,下段3例。行粘膜外肿瘤摘除术28例次,肿瘤及部分食管切除、食管胃主动脉弓上吻合术2例,弓下吻合术3例,肿瘤恶变后探查1例。手术切口为颈部切口3例次,右开胸20例,左开胸11例。本组病例无围手术期死亡。术后随访3年至10年,除1例肿瘤恶变者在术后5年死亡外,其他病例均生存。结论:手术切除是治疗食管平滑肌瘤唯一有效的方法,多数病例可行粘膜外肿瘤摘除术,少数肿瘤巨大或多发者需行肿瘤及部分食管切除、胃食管吻合术。如术后肿瘤复发需考虑肿瘤恶变。

The Surgical Therapy of Oesophageal Leiomyoma (32 cases reports)

Objective: To analyze the diagnosis, therapy and curative effect of oesophageal leiomyoma. Methods: The clinical data for 32 cases of oesophageal leiomyoma, treated with surgical therapy, were studied. Results: Thirty cases with solitary tumors and 2 with multiple tumors were found. According to the position, 2 cases were at the upside of oesophagus, 27 at the midpiece and 3 at inferior segment. Extra-mucosal excision were conducted in 28 cases. Esophagogastrostomy at superior aortic arch were conducted in 2 cases and that at inferior aortic arch were done in 3. The exploration after canceration of tumors was performed in 1 case. As for the operative incision, 3 cases or times were at the cervical part,, 20 at right opened thorax and 11 at left opened chest. No peri-operative death were reported in the cases of the group. Postoperative follows up had been performed for 3 to 10 years. The results showed that all the patients survived except 1 case of post-treatment death within 5 years. Conclusions: Surgical is the only effective method to cure oesophageal leiomyoma. Extra-mucosal tumor extirpation can be performed in most cases, however, excision on tumors or part of esophagus and anastomosis between stomach and oesophagus in a few cases with tremendous or multiple tumors is needed. The canceration of tumors should be first considered in case of postoperative relapse.