术中胃镜定位全胸腔镜下食管平滑肌瘤摘除.PDFVIP

·586 · 南方医科大学学报（J South Med Univ ） 2012;32(4) 临床研究 术中胃镜定位全胸腔镜下食管平滑肌瘤摘除 赵 意，蔡开灿，刘德纲，吴 华，熊 刚，王昊飞，黄志勇，蔡瑞君，吴 旭 南方医科大学南方医院胸心外科，广东 广州 510515 摘要：目的探讨术中胃镜定位全胸腔镜下食管平滑肌瘤手术的治疗经验。方法2006 年1月~2010 年12月共施行食管平滑肌瘤 摘除术75 例，全胸腔镜下平滑肌瘤摘除术55 例，胸腔镜下剥离摘除食管平滑肌瘤操作过程与开胸手术相同。术中使用胃镜对 瘤体进行定位及检查瘤体剥除之后有无粘膜破损，特别是对于肿瘤直径小于2 cm 病人。结果75 例食管平滑肌瘤中，55例在全 胸腔镜下手术，54例均顺利完成，1例为胸腔镜下手术过程中出现室颤而中转开胸，54例全腔镜手术行术中胃镜38例；20 例因早 期未开展胸腔镜手术行开胸手术。使用胃镜在手术时间上优于未使用胃镜，无显著差异（P=0.064），开放手术与腔镜手术在出 血量、术后禁食、住院时间对比均有显著差异（P0.05），手术时间对比无显著差异（P=0.132），肿瘤长径平均2.7 cm (0.5~9.0 cm) ，术后症状均完全缓解，无食管瘘、食管憩室及官腔狭窄等并发症。75 例随访8~59个月，平均23 月，未见复发及狭窄等手术 并发症。结论术中胃镜定位全胸腔镜下食管平滑肌瘤摘除的方法微创、安全、有效，可作为食管平滑肌瘤外科治疗的首选术式。 关键词：食管平滑肌瘤；电视胸腔镜手术；开胸；胃镜 中图分类号：R655.4; R735.1 文献标志码：A 文章编号：1673-4254（2012）04-0586-03 doi: 10.3969/j.issn. 1673-4254.2012.04.034 /kcms/detail/44.1627.R2029.030.html Video-assisted thoracoscopic removal of esophageal leiomyomas with intraoperative tumor location by endoscopy ZHAO Yi, CAI Kaican, LIU Degang, WU hua, XIONG Gang, WANG Haofei, HUANG Zhiyong, CAI Ruijun, WU Xu Department of Cardiothoracic Surgery, Nanfang Hospital, Southern Medical University, Guangzhou 510515, China Abstract: Objective To summarize our experience with video-assisted thoracoscopic (VATS) removal of esophageal leiomyoma located with endoscopy during operation. Methods Between January 2006 and December 2010, 55 patients with esophageal leiomyoma underwent VATS enucleation. The surgical procedure was similar to that of open thoracotomy with intraoperative endoscopic location of the tumor and examination of the mucosal integrity especially for tumors less than 1 cm in diameter. Results Of the 55 patients undergoing VATS tumor removal, 54 patients completed the procedures smoothly, and 1 patient experienced ventricular fibrillation