电视胸腔镜（或辅助小切口）手术治疗食管良性肿瘤56例临床体会

目的总结电视胸腔镜手术（video-assisted thoracoscopic surgery,VATS）治疗食管良性肿瘤的临床经验。方法1995年3月-2008年1月,对56例食管良性肿瘤施行电视胸腔镜（或辅助小切口）手术。在纤维胃镜辅助下,手术采用一个1.5cm左右胸腔镜进镜口加2个2cm左右操作孔或辅助腋下5cm左右小切口完成食管良性肿瘤摘除。结果54例顺利完成VATS（其中8例辅助小切口）食管良性肿瘤摘除术,术后病理证实为食管平滑肌瘤47例,间质瘤7例。1例因平滑肌瘤巨大,食管肌层破坏严重且术中冰冻切片病理检查报告肿瘤生长活跃,1例因术中冰冻切片病理报告低度恶性平滑肌瘤,均中转开胸行食管部分切除、食管胃端侧吻合术。无手术期及围手术期死亡,无术后严重并发症发生。49例随访2-128个月,平均58.6月,无明显进食梗噎等症状出现或复发。结论VATS（或辅助小切口）食管良性肿瘤摘除术具有安全、彻底、有效、可行等特点,可作为食管良性肿瘤摘除术的首选治疗方法。

Video-assisted Thoracoscopy for Benign Esophageal Neoplasm: Report of 56 Cases

Objective To report our experience on video-assisted thoracoscopic surgery(VAMT)for the treatment of benign esophageal neoplasm.Methods A total of 56 patients with benign esophageal neoplasm received VATS with or without auxiliary mini-thoracotomy in our hospital from March 1995 to January 2008.Under the assistance of a fiber gastroscope,through a 1.5-cm and two 2-cm incisions,the neoplasm was removed by using 3 trocars.In some cases,a 5-cm subaxillary incision was made.ResultsAmong the cases,the neoplasm was removed in 54 patients with VATS(with auxiliary mini-thoracotomy performed in 8),in which postoperative pathological examination showed esophageal leiomyoma in 47 and interstitialoma in 7.Two patients were converted to open surgery because of huge leiomyoma invading the muscular layer with an active growth,or low-malignant potential leiomyoma.Partial esophagectomy and end-to-end anastomosis were carried out in these two patients.No patient died intra-or peri-operation.No serious postoperative complication occurred in this series.A 2-to 128-month follow-up(mean,58.6 months)was achieved in 49 of the patients,none of them complained of dysphagia or developed recurrence during the period.Conclusions VATS(combined with mini-thoracotomy)is safe and effective for benign esophageal neoplasm.It can be the first choice for the treatment of the disease.