腹腔镜胃切除手术治疗胃间质瘤

Application of laparoscopic gastric resection for gastrointestinal stromal tumors

目的:探讨腹腔镜手术治疗胃间质瘤(gastric stromal tumors,GST)的临床应用价值。方法:回顾分析2003年6月至2009年2月间接受腹腔镜手术的36例GST病人的临床资料,包括手术方式、手术时间、术中失血、术后排气时间、术后住院天数、并发症、术后病理及随访资料等。结果:所有GST切除手术均在腹腔镜下完成,其中行腹腔镜胃楔形切除者21例,腹腔镜经胃肿瘤外翻切除术者12例,腹腔镜辅助远端胃切除术者2例,腹腔镜辅助下内镜胃间质瘤圈套套扎术者1例。无一例病人中转开腹手术,手术平均时间为75(30～210)min,术中平均失血60(5～150)mL,肿瘤平均大小3.0(0.5～11.5)cm,肿瘤切缘镜下均为阴性;术后平均排气时间2(1～11)d,手术后平均住院天数8(3～13)d。1例病人出现术后胃腔内出血,经保守治疗后1d出血即停止,其余病例无重大术后并发症。术后平均随访25(4～67)个月,所有病人均无肿瘤复发和远处转移。结论:腹腔镜辅助胃切除是治疗GST之安全、可行、微创、有效的手术方法。

Objective To evaluate laparoscopic gastric resection for gastrointestinal stromal tumors （GIST）. Methods From Jun. 2003 to Jun Feb. 2009, 36 patients with gastric GIST underwent laparoscopic gastric resection, they were retrospectively reviewed and analyzed with the surgical procedure, operative time, blood loss, time for passage of flatus, post-operative hospital stay, complications and pathology. Results All patients underwent laparoscopic gastric resection successfully without conversion to open surgery, including 21 laparoscopic wedge resection, （LWR）, 12 laparoscopic transgastric tumor-everting resection （LTGTER）, 2 laparoscopy-assisted distal gastrectomy （LADG） and 1 laparoscopiy-assisted endoscopic resection. The mean operative time was 75 （30-210） min, quantity of blood loss was 60 （5-150） mL, time for passage of flatus was 2 （1-11） d and the post-operative hospital stay was 8 （3-13） d. Except one patients （2.8%） with anastomostic bleeding, no operative complication occurred in the other cases. The resection margin of the tumor was microscopically negative, and the median size of the tumor was 3 （0.5-11.5） cm. After 25 （4-67） months of follow-up, there was no recurrence or metastasis. Conclusions Laparoscopic gastrric resection is a safe, feasible, effective and minimally invasive surgery for gastric GIST.