电视胸腔镜手术治疗食管平滑肌瘤

目的探讨电视胸腔镜手术治疗食管平滑肌瘤的安全性和可行性。方法1996年9月～2009年2月共施行电视胸腔镜食管平滑肌瘤摘除术49例。手术通过3～4个胸壁小切口完成,镜下剥离摘除食管平滑肌瘤操作与开胸手术基本相同。结果42例在胸腔镜下顺利完成手术,7例中转开胸（2例因胸膜腔致密粘连,3例因肿瘤〈1.0cm,胸腔镜下无法定位,2例因肿瘤较大并与食管黏膜粘连紧密）。手术时间平均90min（50～210min）,肿瘤长径平均3.7cm（0.5～10.0cm）,无严重并发症及手术死亡。43例随访1～73个月,平均27.1月,无复发。结论电视胸腔镜食管平滑肌瘤摘除术安全可靠,可替代大部分常规开胸手术。

Treatment of Esophageal Leiomyoma by Video-assisted Thoracoscopic Surgery

Objective To evaluate the efficacy and safety of video-assisted thoracoscopic surgery in the treatment of esophageal leiomyoma. Methods Clinical data of 49 patients with esophageal leiomyoma from September 1996 to February 2009 treated by video-assisted thoracoscopic enucleation were reviewed retrospectively. Three or four trocars were used during the operation. The procedure of the surgery was similar to that of open thoracoscopic enucleation. Results In the 49 patients, video-assisted thoracoscopie leiomyoma enucleation was successfully completed in 42 cases. The other 7 patients were converted to open thoraeotomy because of the following reasons： dense pleural adhesion in 2, location failure of small tumor （ 〈 1.0 cm） in 3, and large tumor adherent to the mucosa in 2. The mean operation time was 90 min （50 to 210 min）. Mean tumor size was 3.7 cm in diameter （0.5 - 10 cm）. No significant complications or death occurred in this series. The patients were followed up for 1 to 73 months （mean, 27.1 months）, no recurrence was found during the period. Conclusion Video-assisted thoracoscopic enucleation can be an alternative to open surgery for patients with esophageal leiomyomas, as it is safe and effective.