食管平滑肌瘤的诊断及外科治疗

目的　探讨食管平滑肌瘤的诊断及外科治疗特点。方法　对 14 1例食管平滑肌瘤患者的术前影像学、内窥镜资料及外科治疗结果进行回顾性分析。结果　食管平滑肌瘤患者的主要症状为吞咽不顺 (6 4 .5 % )及胸部或上腹部疼痛 (2 0 .6 % ) ,平均病史 15 .7个月。 11例术前误诊为食管恶性肿瘤、纵隔或腹膜后肿瘤。 13例行食管部分切除术 ,其中 2例肿瘤巨大 ,3例术中仍误诊为食管恶性肿瘤 ,8例并存食管癌或贲门癌。 12 8例行肿瘤摘除术 ,13例术中黏膜破裂并予以修补。肿瘤单发 130例 ,多发 11例。瘤体呈类圆形、马蹄形或不规则形 ,包绕食管周经 <1/ 2者 75例 ,>1/ 2者 5 9例 ,累及全周者 7例。肿瘤呈息肉状管腔内生长 1例 ,管壁外生长 2例 ,其余均管壁内生长。本组无手术死亡 ,手术并发症发生率 3.6 %。结论　食管平滑肌瘤易误诊为食管恶性肿瘤或纵隔肿瘤 ,应注意鉴别诊断。术式选择应尽可能行肿瘤摘除术。食管镜检查疑为平滑肌瘤时应避免活检。食管平滑肌瘤患者食管癌发病率较高 ,其原因有待探讨

Diagnosis and surgical treatment of esophageal leiomyoma

Objective To study the characteristics of diagnosis and surgical treatment of esophageal l eiomyoma. Methods Preoperative radiology, esophagoscopy and results of surgical treatment were ret rospectively analyzed in 141 patients with esophageal leiomyoma. Results Dysphag ia (64.5%) and chest or epigastric pain ( 20.6%) were the most common presenting symptoms with a mean duration of 15.7 months. Eleven patients had been misdiagnosed as malignant esophageal disea se, mediastinal or retroperitoneal tumor before operation. Thirteen patents rece ived partial esophageal resection, including 2 patients with gigantic tumor, 3 s till misdiagnosed as malignancy in the operation theater and 8 accompanied with esophageal or gastric cardiac carcinoma. 128 patients were treated with tumor re moval only, among whom the esophageal mucosa was ruptured and sutured in 13 pate nts. The tumor was single in 130 patients and multiple in 11 patients. The tumor shape was either oval, horseshoe or ginger like. Tumor surrounded the esopha gus less t han half circumference in 75 patients, more than half in 59 patients and involve d the whole circumference in 7 patients. The tumor was polypoid and intraluminal in one patient. It was extraluminal in 2 patients and was intramural in all the others. The morbidity and 30 day mortality rates were 3.6% and 0%. Conclusion Preoperative differentiation of esophageal leiomyoma is important for it may be misdiagnosed as esophageal malignant disease or mediastinal tumor. Tu mor removal only is indicated if possible. Biopsy is inadvisable if leiomyoma ha s been suspected by esophagoscopy. The incidence of esophageal carcinoma complic ating esophageal leiomyoma is high, of which the reason needs further study.