Efficacy and safety of ultramicro invasive surgery of huge esophageal masses by single aperture thoracoscope combined with esophagoscope: 2 cases report
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摘要:
目的 探讨超微创外科手术在治疗食管巨大肿物上的有效性与安全性, 以期为食管超微创治疗提供新思路、新方法。 方法 回顾性分析我院胸外科收治的2例食管巨大肿物患者, 采取单孔胸腔镜配合食管镜双镜联合超微创手术的治疗方式, 统计2例患者的手术时间、术中出血量、术后胸管留置时间、引流量、住院时间、病理结果及严重术后并发症发生率。 结果 2例患者在双镜联合超微创手术下, 均成功切除食管巨大肿物。手术时间平均约230 min, 术中出血量平均约20 mL。术后胸管留置时间均为3 d, 引流量平均约395 mL, 术后平均住院时间为7 d。均未出现术中转开胸、食管瘘、肺部感染等严重术后并发症。术后病理检查均提示食管平滑肌瘤, 均治愈出院。 结论 单孔胸腔镜联合食管镜超微创手术为食管巨大平滑肌瘤的外科治疗, 提供了新的方向和技术支持, 其疗效与安全性较单一使用单孔/多孔胸腔镜或联合食管镜具有更明显的优势。 Abstract:Objective To explore the efficacy and safety of ultramicro invasive surgery in the treatment of huge esophageal tumors, and to provide new ideas and new methods for the treatment of esophageal ultrainvasive surgery. Methods A retrospective analysis was made on two patients with large esophageal masses who were treated by single-port thoracoscope combined with esophagoscope and double-mirror combined with ultramicroscopic surgery in our hospital.We counted the operative time, intraoperative blood loss, postoperative chest tube indwelling time, drainage volume, length of hospital stay, pathological results and the incidence of serious postoperative complications in two patients. Results The huge esophageal masses of two patients were successfully resected by double mirror combined with ultramicroscopic surgery.The average operation time was about 230 min, and the average intraoperative bleeding was about 20 mL.Postoperative retention time of chest tubes was 3 d, the average drainage volume was about 395 mL, and the average postoperative hospital stay was 7 d.There were no serious postoperative complications such as thoracotomy, esophageal fistula and pulmonary infection.Postoperative pathological examination showed esophageal leiomyoma.Both patients were cured and discharged from hospital. Conclusion Single-aperture thoracoscope combined with esophagoscope ultramicroscopic surgery provides a new direction and technical support for the surgical treatment of giant esophageal leiomyoma.Compared with single-aperture/multi-aperture thoracoscope or combined esophagoscope, its efficacy and safety have more obvious advantages. -
图 1 患者胸部CT（红箭头示正常食管及食管巨大肿物）
Figure 1. CT of patient's chest (circle showed normal oesophagus, red arrow shows large oesophageal mass).
图 2 患者食管钡餐造影（红箭头示食管狭窄处）
Figure 2. Patient's barium oesophagogram (red arrow showed the oesophageal stricture).
图 3 术后病理：食管平滑肌瘤（HE染色）
Figure 3. Postoperative pathology: oesophageal smooth muscle tumour (HE staining, A: 40×; B: 200×).
表 1 2位患者围术期基本情况
Table 1. Basic information of two patients during perioperative period
Patient Surgical time (min) Intraoperative bleeding (mL) Chest tube retention time (d) drainage volume (mL) Postoperative hospitalization time (d) Postoperative complications Pathological results Patient A 340 25 4 400 7 No Leiomyoma Patient B 120 15 2 390 7 No Leiomyoma Mean 230 20 3 395 7 / / 
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