Esophageal smooth muscle tumors: are benign tumors that occur in the esophagus and originate from smooth muscle cells. Benign esophageal tumors are rare, accounting for less than 1% of all esophageal tumors. Nearly two-thirds of benign esophageal tumors are smooth muscle tumors; most of the others are polyps and cysts. Thus, esophageal smooth muscle tumors are the most common benign esophageal tumors. Tumors can occur in any part of the esophagus, but the middle segment is the most common, the lower segment is the second most common, the upper segment is the least common, and very few are in the cervical segment, because the cervical segment of the esophagus is composed of random muscle, and not many are in the ventral segment, so it is not easy to distinguish between the esophagus or the cardia muscle layer. Most of the tumors are solitary, and only about 2% to 3% are multiple, ranging from 2 to more than 10. Tumors vary in size, with those of 2-5 cm being the most common. About half of the patients with smooth muscle tumors are completely asymptomatic and are detected by chest X-ray or gastrointestinal angiography for other diseases. The most common symptom is mild dysphagia, which rarely affects normal diet. Even if the tumor is quite large, the obstructive symptoms are not heavy because of its slow development. This is of great significance in the differential diagnosis and is not quite the same as the short-term progressive dysphagia caused by esophageal cancer. Examination methods: 1.Barium meal examination of upper gastrointestinal tract 2.Electrofiber esophagoscopy 3.CT and magnetic resonance examination 4.Ultrasonic endoscopy Differential diagnosis 1.Mediastinal tumor: When large esophageal smooth muscle tumor grows outside the wall, it can cause soft tissue shadow in the mediastinum, which can be easily mistaken for mediastinal tumor, therefore, for the masses in the posterior lower mediastinum that are closely related to the esophagus, do not be satisfied with the diagnosis of mediastinal tumor, and be alert to the presence of esophageal The presence of smooth muscle tumor should be alerted. 2.Esophageal cancer: Larger esophageal smooth muscle tumor involves longer esophagus, and the mucosa in the lesion area is thin and can be accompanied by congestion and other manifestations, so it is easy to mistake the destruction of mucosa and diagnose it as esophageal cancer during esophagogram. 3. Mediastinal lymph nodes or inflammatory masses: Because the symptoms of esophageal smooth muscle tumor show difficulty in swallowing, barium meal examination shows filling defect in the middle part of esophagus, and esophagoscopy shows smooth spherical lesions in the middle part of esophagus, which also has similar performance in cases of mediastinal lymph node enlargement or inflammatory masses. In this case, if a lateral film or CT scan is taken at the same time as the barium esophagogram, the diagnosis of external pressure esophageal obstruction may be clarified. 4.Some physiological variants: for example, external compression of the right vagus subclavian artery or saccular aneurysm, smooth indentation area produced by the left main bronchus and aortic arch, also need to be distinguished from the less common vertebral body attachment compression. Although barium esophageal meal is the preferred method to diagnose esophageal smooth muscle aneurysm, CT is an excellent further test if it is difficult to differentiate from external compression lesions, especially if the lesion is located at the level of the aortic arch and tracheal ramus. Treatment Although smooth muscle tumor is asymptomatic and grows slowly, it can become symptomatic later. Therefore, except for very small tumors with a diameter of 1 to 2 cm or less, those without any symptoms, or patients who are old and weak, with low cardiopulmonary function and other physical conditions that are not suitable for surgery, surgery is appropriate once diagnosed. The surgical method and degree of difficulty can be determined according to the tumor site, size, shape, mucosal fixation, extent of gastric involvement and adhesion with surrounding tissues in a few cases. Surgery is mainly for extra-mucosal tumor removal. 1.Surgical treatment of esophageal smooth muscle tumor is benign, but it has the tendency of malignant transformation, and the long-term growth of tumor can compress the surrounding organs and bring a series of complications, so once it is diagnosed, especially if the tumor is large and the symptoms are obvious, it should be removed surgically. Surgical methods 1.Extra-mucosal tumor removal plus muscle layer repair This procedure is suitable for small tumor and no adhesion between tumor and mucosa, and is the ideal procedure, that is, after entering the chest, free a section of local esophagus where the tumor is located, then dissect the esophageal muscle layer and tumor envelope longitudinally, remove the tumor completely outside the mucosa, and then close the muscle layer incision intermittently. 2.TV thoracoscopic extramucosal tumor removal For esophageal smooth muscle tumor with clear diagnosis, it can also be removed by TV thoracoscopy. It is believed that benign smooth muscle tumor with the size of about 5cm×5cm×5cm can be removed by TV thoracoscopy, which is supplemented by TV esophagoscopy to monitor whether there is any damage to mucosa, and at the same time, endoscopic inflation can assist the intrathoracic dissection to free the smooth muscle tumor. 3.Partial esophagectomy Some authors believe that for those who have large tumor with circular growth and serious adhesion with esophageal mucosa and those who have heavy damage to esophageal mucosa during operation and have difficulty in repair, the scope of resection should be expanded and partial esophagectomy should be performed. If the tumor is malignant, partial esophagectomy should also be performed. 4.Gastroesophageal partial resection Huge esophageal smooth muscle tumor is commonly found in the lower part of esophagus and can extend to cardia or stomach, forming serious adhesions with gastric mucosa and local gastric mucosa ulcers, requiring partial esophagectomy. According to the analysis of 838 cases of esophageal smooth muscle tumor by Seremitis in 1976, about 10% of cases require partial gastroesophagectomy and reconstruction of the digestive tract. C. Tumors involving the esophagogastric junction, and it is difficult to perform simple mucosal tumor removal; D. Tumors forming dense adhesions with the esophageal mucosa, and it is impossible to separate and remove the tumors from the mucosa. Esophageal and gastric resection and reconstruction are suitable for those who have large and irregular tumors, which are not easily separated from the mucous membrane, some multiple smooth muscle tumors which are not easily removed, and those who are suspected of malignant change and cannot exclude the possibility of malignant change during surgery.