腹腔镜胃楔形切除术治疗胃底部间质瘤

Laparoscopically extraluminal wedge-resection in treatment of stromal tumor of the gastric fundus

目的:总结腹腔镜胃底楔形切除术治疗胃底部间质瘤的可行性及其临床应用价值。方法:采用4孔法。手术主要步骤为肿瘤定位、网膜游离、胃底和脾上极分离、食管贲门连接处(esophagocardiac junction,ECJ)显露以及用内视镜切割吻合器楔形切除胃底间质瘤。结果:79例手术均获成功,手术时间平均为(60.1±6.6)min;术中平均出血(56.2±6.7)ml。无病灶遗漏,也无并发症和手术中转。术后平均住院(4.6±0.5)d。78.5%病人于术后36 h内恢复胃肠功能,并开始进食和下床活动。结论:腹腔镜胃腔外胃底楔形切除术对胃底,尤其是对后壁近ECJ黏膜下肿瘤的治疗是安全、简便和有益的,可以避免腹腔污染、脾脏损伤以及术后食管狭窄的发生;同时,胃的切除范围也不受限。

Objective To evaluate the clinical feasibility of laparoseopieally extraluminal wedge-resection in treatment of stromal tumor of the gastric fundus. Methods The procedure was performed with four troears, it ineluded localization of the tumor, dissection of the omentunl, mobilization of the gastric fundus and the upper pole of spleen. exposure of the esophagocardiac junction （ECJ）, and wedge-reseetion of stromal tumor of the gastric fundus with Endo GIA. Results The dul＇ation of operation averaged （60.1±6.6） inin. The average amount of bleeding was （56.2±6.7） ml. The mean post-operative hospital stay was （4.6±0.5） d. Thirty six hours post-operatively. 78.5% （62/79） of the patients recovered their gastrointestinal function and began to eat and ambulate. In all the 79 operations, no tumor tissue was left over, and no complication or conversion to open surgery occurred. Conclusions The newly designed procedure helps to avoid abdominal eavity contamination, injury to the spleen and postoperatively esophageal stenosis. And there is no limit as to the extent of gastric resection. Therefore. the procedure is botb safe and effective.