腹腔镜胃切除治疗胃间质瘤26例临床报告

Laparoscopic gastrectomy in the treatment of gastric stromal tumor:a report of 26 cases

目的:探讨腹腔镜胃切除术治疗胃间质瘤的安全性及可行性。方法:2003年8月至2007年9月间,26例胃间质瘤病人在腹腔镜下行胃部分切除手术,其中17例行胃楔形切除、6例近端胃切除、3例远端胃切除。结果:无中转开腹,无手术死亡。手术平均出血量15(10～75)ml,平均手术时间(144±74)min,平均切口长度(5.5±1.5)cm,平均术后住院日为(8.3±3.6)d。手术并发症发生率7.69%(2/26),其中1例肺感染、1例切口感染。病理结果:极低度风险8例、低度风险12例、中度风险4例、高度风险2例。随访3～48个月,2例病人出现肝转移、现带瘤生存,其余无瘤生存,目前总生存率100%,复发率7.69%(2/26),3年无瘤生存率96.0%。结论:腹腔镜下胃切除术治疗胃间质瘤是安全、可行的,手术近期疗效令人满意,远期结果有待进一步观察。

Objective To evaluate the safety and feasibility of laparoscopy-assisted gastrectomy in the treatment of gastric stromal tumor. Methods The clinical data from 26 cases of gastric stromal tumors admitted from August 2003 to June 2007, were analyzed retrospectively. Among these patients, 17 cases underwent gastric wedge resection, 6 with proximal gastrectomy and the other 3 with distal gastrectomy. Results Operations were performed successfully in all the patients. There was no death and conversion to open surgery. The average blood loss was 15（10-75） ml, the mean operation time （144±74） min, the mean length of assisted incision （5.5±1.5） cm, and the mean postoperative hospital stay （8.3±3.6） days. The morbidity was 7.69%（2/26）, one patient developed incisional infection, another one had postoperative pneumonia. Pathologic findings of the 26 resected specimens demonstrated that the number of patients with low, intermediate and high risk lesions were 20,4, and 2 respectively. All patients had been followed up for 3 to 48 months. Only 2 cases developed multiple liver metastases, but were still alive up to the present. The survival data were as following：. OS 100% and DFS 92.31%（24/26）; the recurrence rate was 7.69%（2/26）. Conclusions Laparoscopy-assistod gastrectomy is safe and feasible for gastric stromal tumor, with a satisfactory short-term outcome, but the long-term outcome needs to be further observed.