腹腔镜辅助小肠间质瘤切除术15例

Laparoscopic-assisted Resection of the Small Intestine for Stromal Tumors:Report of 15 Cases

目的探讨腹腔镜辅助小肠间质瘤切除术的疗效。方法2003年1月～2007年5月,10例小肠占位性病变、5例腹痛伴便血诊断不清共15例在全麻下行腹腔镜探查,发现小肠病变后在腹壁合适部位做小切口,将病变肠段提出腹壁外切除、吻合,回纳肠段关腹后重建气腹,观察肠段血运及腹腔内有无出血。结果15例手术均顺利完成。术后诊断为间质瘤,CD117阳性14例(93%),CD34阳性9例(60%)。极低危险性3例(20%),低危险性5例(33%),中危险性4例(27%),高危险性3例(20%)。肿瘤直径1.5～3.6cm,(2.44±0.63)cm。手术时间38～72min,(57.8±10.4)min。术中出血10～30ml,(20.1±6.5)ml。术后排气时间16～42h,(27.8±9.3)h。术后住院4～7d,(5.3±1.1)d。无并发症发生。15例随访5～36个月,(24.3±8.4)月,无复发。结论腹腔镜辅助小肠间质瘤切除术具有良好效果。

Objective To evaluate the efficacy of laparoscopic-assisted resection of the small bowel for stromal tumors. Methods From January 2003 to May 2007, laparoscopic abdominal exploration was carried out under general anesthesia on 10 patients with space occupying lesion and 5 patients with abdominal pain and hemafecia of unknown origin. After an intestinal lesion was found, a small incision was made at the proper site on the abdominal wall according to the location of the lesion. The diseased intestine was resected outside the abdominal cavity, and then end-to-end anastomosis was performed. Pneumoperitoneum was rebuilt after closing the abdominal cavity in order to observe the blood circulation of the small bowel and intra-abdominal hemorrhage. Results The operation was completed in all the 15 cases. The postoperative pathological examination showed stromal tumors with CDH7 positive in 14 cases （93%） and CD34 positive in 9 （60%）. Three （20%） of the patients were at very low risk, 5 （33%） at low risk, 4 （27%） at moderate risk, and3 （20%） at high risk. The mean diameter of the tumors was （2.44±0.63） cm （ranged from 1.5 to 3.6）. The operation time was 38 to 72 minutes with a mean of （57.8 ±10.4）, and mean blood loss was （20.1 ＋6.5） ml （10 to 30）. The patients were discharged 4 to 7 days after the operation [ mean, （5.3 ± 1.1 ） days ] , and were followed up for 5 to 36 months [ mean, （24. 3 ± 8.4） months ]. No patient had postoperative complications or recurrence in this series. Conclusion Laparoscopy is effective for resection of small bowel stromal tumors.