Esophageal Leiomyoma Resection

The surgical approach and difficulty of esophageal leiomyoma depends on the location, size, shape of the tumor, the relationship with the stomach or cardia (whether the tumor involves the stomach or the cardia), and whether the tumor and the esophageal mucosa have serious adhesions. Extramucosal tumor removal is a well-recognized surgical procedure, that is, a segment of the esophagus at the site of the free tumor after the chest is inserted, and then the esophageal muscle layer and the tumor capsule are cut longitudinally, and the tumor is completely removed outside the mucosa, followed by intermittent suture Muscle incision. Some authors believe that for patients with large tumors, ring growth and severe adhesion to the esophageal mucosa, and severe intraoperative esophageal mucosal injury, if the repair is difficult, the scope of resection should be extended and partial esophagectomy should be performed. If the tumor has malignant changes, partial esophagectomy should also be performed. Giant esophageal leiomyoma is common in the lower esophagus and can extend to the cardia or stomach, forming a serious adhesion to the gastric mucosa, ulceration of the local gastric mucosa, and partial esophagogastric resection. Treatment of diseases: esophageal sarcoma esophageal leiomyoma Indication Regardless of the presence or absence of symptoms, the larger the tumor, should be elective surgery. When the nature of the tumor is not easy to determine, surgery should be performed early because malignant changes can occur in a few cases. The diagnosis is clear, but the symptoms are not significant, the tumor is small (the diameter is not more than 2cm) or the patient is older and the physical condition is not suitable for surgery. It can be observed and reviewed regularly. Preoperative preparation 1. Esophageal barium meal or esophagoscopy examination of lesions and size. 2. Place the stomach tube before surgery. Surgical procedure 1. Incision: esophageal leiomyomas are located in the cervical segment for the anterior oblique oblique incision of the sternocleidomastoid, 5~7cm long, and the upper thoracic segment is the 5th or 6th intercostal incision in the right posterior aspect, the middle or lower thoracic region, The right posterolateral incision or the left posterolateral incision was taken according to the orientation of the tumor, and the median incision in the left upper abdomen was only used for the tumor near the cardia. 2. Propose the esophagus and longitudinally cut the muscle layer on the surface of the tumor. 3. Carefully and bluntly separate along the outer membrane of the tumor between the esophageal muscle layer and the submucosal layer. The tumor bulges out of the muscle layer. Care should be taken to avoid damage to the esophageal mucosa. 4. After the tumor is removed, the wound completely stops bleeding. If the esophageal mucosa is found to be damaged, the filaments can be sutured intermittently. The esophageal muscle layer is then sutured intermittently. complication If the esophageal mucosa is damaged during the operation and the defect is not repaired or damaged, the esophageal fistula may be complicated and cause serious consequences, such as high fever, difficulty in breathing, rapid pulse, pleural effusion or liquid pneumothorax. More prompts of esophageal fistula, esophageal iodine angiography or oral methylene blue solution after thoracic puncture examination, can confirm the diagnosis, should be processed in time. Small esophageal fistula, transthoracic closed drainage, fasting, anti-infection and parenteral nutrition, sputum can gradually heal; esophageal fistula is large, if early detection, patient conditions permit, should be cut chest in time Repair or partial esophagectomy, esophagogastric anastomosis. After the removal of large esophageal leiomyoma, due to weak local esophageal muscle layer or scar adhesion, esophageal stenosis or pseudo-esophageal diverticulum may be complicated. Therefore, unnecessary surgical trauma should be avoided during surgery to repair the defects of the esophageal wall. Esophageal dilatation is often required for patients with dysphagia due to narrow esophageal scars.