RESULTS OF SURGICAL TREATMENT OF ESOPHAGEAL AND CARDIOESOFAGEAL LEIOMYOMAS

R.E. LIGAY, Kh.N. BEKCHANOV, A.O. TSOY, R.R. OMONOV

Republican Specialized Centre of Surgery named after acad. V. Vakhidov, Tashkent,

UZBEKISTAN

Purpose: To examine the results of surgical treatment in patients with benign esophageal tumors.

Material and methods of study: 25 patients with benign esophageal tumors were treated at the Department of esophageal and gastric surgery in the period from 1994 to 2011. After a comprehensive examination (endoscopy with biopsy, X-ray and morphological study) esophageal and cardioesophageal leiomyomas were diagnosed in all the patients. Patients were divided into following groups according to the location of leiomyomas: the middle third of the esophagus - 5 patients, the lower third of the esophagus - 14 and cardioesophageal passage - 6 patients. The main clinical symptom in patients with leiomyomas was dysphagia, which was found in all patients, 5 patients had in their anamneses signs of esophageal bleeding of unknown etiology. In 24 patients, leiomyoma were single, and 1 patient there were diagnosed multiple (n = 5) leiomyomas of the proximal segment of the stomach, cardioesophageal passage and lower third of the esophagus.

Results and discussion: 1 patient with multiple esophageal and gastric leiomyomas were performed proximal gastric resection with the formation of invaginated areflux esophagogastroanastomosis. The remaining 24 patients were performed operations leiomyoma husking, which is the method of choice in this pathology and refers to a group of organ-preserving interventions. The nature of a surgical access was determined by the localization of leiomyomas. In 5 patients with leiomyomas of the middle third of the esophagus there was used right-thoracic access, in others – abdominal with sagittal diaphragmo crurotomia by Savinykh. In leiomyoma husking it is necessary to preserve the integrity of the mucous membrane, however in 4 cases there occurred lancing of the esophageal lumen due to the large sizes of the tumor and “intimate” adhesion with the mucosa. In this situation, precise suturing of muco-submucosal and muscular layer on thick gastric tube for the prevention of the narrowing of esophageal lumen is necessary. In 1^st case, there occurred failure of sutures of the sutured area of ​​the esophagus, which was resolved by conservative measures. All the operated patients were discharged in satisfactory condition. In the allotted period up to 5 years signs of recurrence were not identified.

Conclusion: Surgical treatment of patients with esophageal leiomyomas and leiomyomas of cardioesophageal passage is radical, where tumors “husking” should be priority in this category of patients.

Date: 2014-12-28; view: 1016