Surgical Enucleation of a Huge Esophageal Schwannoma Causing Dysphagia and Exertional Dyspnea

手術摘除造成吞嚥困難及活動性喘的巨大食道神經鞘瘤

李威億(Wei-Yi Lee) ； 夏君毅(Jiun-Yi Hsia)

《胸腔醫學》 34卷4期 (2019/08) Pp. 166-171

摘要

Benign esophageal tumors are not common, and most of them are leiomyomas; schwannomas are rarely seen. Symptoms worsen as the tumor increases in size. A preoperative diagnosis is difficult, and the definitive diagnosis is often established by histological features and immunohistochemical stain after surgery. An 82-year-old woman had dysphagia for 2 years and exertional dyspnea for 1 year. She had a huge esophageal submucosal tumor with nearly total obstruction of the middle esophagus and compression of the left main bronchus. Tumor enucleation followed with primary suture of the mucosal defect through a right mini-thoracotomy under video-assistance was performed successfully. To our knowledge, this is the first report of an elderly woman with a huge schwannoma located in the middle esophagus that was successfully treated with surgical enucleation instead of total or subtotal esophagectomy.

關鍵字

esophageal schwannoma ； dysphagia ； dyspnea ； enucleation

並列摘要

良性食道腫瘤是不常見的，其中最常見的是平滑肌瘤，而神經鞘瘤是相當罕見的，造成的症狀會隨著腫瘤變大而加劇。術前要有確切的診斷是有難度的，通常需要在開刀後，藉由檢體的組織特性和免疫組織化學染色來得到最終診斷。本案例是一位82歲女性，有吞嚥困難兩年及活動性喘一年，檢查後發現在食道中段有一巨大的黏膜下腫瘤，造成食道幾乎完全阻塞，左邊主要支氣管也被壓迫到。於是我們為這位病人安排了胸腔鏡輔助下食道腫瘤摘除及黏膜修補手術。經由文獻搜尋，這是第一例成功地以手術摘除巨大中段食道神經鞘瘤，而非全食道或部分食道切除。

並列關鍵字

食道神經鞘瘤 ； 吞嚥困難 ； 呼吸困難 ； 手術摘除