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Revista do Colégio Brasileiro de Cirurgiões

Print version ISSN 0100-6991On-line version ISSN 1809-4546

Rev. Col. Bras. Cir. vol.27 no.1 Rio de Janeiro Jan./Feb. 2000

http://dx.doi.org/10.1590/S0100-69912000000100015 

RELATOS DE CASOS

 

Leiomiomas do esôfago removidos por vídeo- toracoscopia

 

Videothoracoscopic resection of esophageal leiomyomas

 

 

João Luiz M. C. Azevedo, TCBC-SPI; Jean BoulezII; Otávio AzevedoIII 

IProfessor Adjunto Doutor do Departamento de Cirurgia da Universidade Federal de São Paulo (UNIFESP), Escola Paulista de medicina (EPM-SP). Professor convidado da Universidade Claude Bernard, Lyon, França
IIProfessor Titular do Departamento de Cirurgia Geral e Digestiva da Faculdade de Medicina da Universidade Claude Bernard, Lyon, França
IIIResidente de Cirurgia Gastroenterológica do Hospital do Servidor Público do Estado de São Paulo

Endereço para correspondência

 

 


ABSTRACT

This report describes three cases of esophageal leiomyomas successfully resected by thoracoscopy. Surgical enucleation through minimally invasive surgery is the treatment of choice for esophageal leiomyoma. The conventional approach through a formal thoracotomy has the potential of causing excessive pain and patient discomfort. Moreover, the hospital stay and the recovery period are prolonged. Indications for surgery were based mainly on the size of the mass (<4 cm) and the presence of dysphagia. In one case there was a clear suspicion of malignancy. The tumour was located in the lower thoracic esophagus (case 1), in the middle thoracic esophagus (case 2) and in the upper esophagus (case 3). The CT was useful in identifying the relationship between the lesion and the organs of the mediastinum. The barium swallow study was able to locate the lesion along the esophagus. The endosonography determined the boundaries of the lesions. A right thoracoscopic approach was undertaken. Dissection of  the esophagus around its entire perimeter was never necessary because all tumours were anterior or right sided. The tumours were better grasped with a traction suture than with forceps. The hidrodissection was very helpful. The water-soluble contrast swallow, performed on the fourth postoperative day, was normal. Clinical results were satisfactory in all patients. Biopsies should never be performed when the mucosa overlying is normal.

Key words: Thoracic surgery; Esophageal surgery; Surgical techniques; Benign esophageal neoplasms; Benign neoplasm.


 

 

Texto completo disponível apenas em PDF.

Full text available only in PDF format.

 

 

REFERÊNCIAS

1. Partensky S, Caillon P, Berger F, et al. Apport de la tomodensitométrie au diagnostic et au traitement du polype fibrovasculaire de I'esophage. Chirurgie 1998;114:217-222.         [ Links ]

2. Rosch T, Lorenz R, Dancygier H, et al. Endosonographic diagnosis of submucosal upper gastrointestinal tract tumors. Scand J Gastroenterol 1992;27:1-8.         [ Links ]

3. Seremetis MG, Lyons WS, de Guzman YC, et al. Leiomyomata of the esophagus: an analysis of 838 cases. Cancer 1976; 38:2.166-2.177.         [ Links ]

4. Peracchia A, Bonavina L, Bardini R, et al. Thoracoscopic enucleation of esophageal leiomyoma. In: Peters JH, DeMeester TR, editors. Minimally Invasive Surgery of the Foregut. St. Louis:Quality Medical Publishing, 1994:239-243.         [ Links ]

5. Gossot D, Fourquier M, Meteini E, Celerier M. Technical aspects of endoscopic removal of benign tumours of the esophagus. Surg Endosc 1993;7:102-103.         [ Links ]

 

 

Endereço para correspondência:
Prof. Dr. João Luiz M. C. Azevedo
Universidade Federal de São Paulo - Escola Paulista de Medicina Ed. Técnica Operatória - Rua Botucatu, 740 - Térreo
V. Clementino - 04023-000 - São Paulo - SP
E-mail: jozevedo.dcir@epm.br
Site: Http://www.cirurgiaonline.med.br

Recebido em 25/1/99
Aceito para publicação em 28/10/99

 

 

Trabalho realizado no Serviço de Chirurgie Générale et Digestive, Fédération des Spécialités Digestives, Pavillon D-O, Hospital Edouard Herriot, Lyon, França.

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