胃间质瘤的早期诊断及微创治疗

The early diagnosis and minimally invasive resection for gastric stromal tumors

目的探讨胃镜、超声内镜、腹腔镜联合应用在小的胃间质瘤（直径〈5cm）诊断和治疗中的作用和价值。方法自2004年8月至2009年12月，对胃镜发现的胃黏膜下隆起性病变43例，进行超声内镜检查，初步诊断胃间质瘤29例（直径0．89～3．85cm，平均1．78cm）。随后在胃镜辅助定位下，行腹腔镜胃部分切除术。术后长期随访有无局部复发及远处转移。结果手术全部成功，手术时间35。90min，平均55min，无术后并发症及死亡病例。术后胃肠功能恢复时间18～36h，平均28h。住院时间3～5d，平均3．6d。术后病理诊断间质瘤者28例，神经鞘瘤1例，术前诊断符合率96．5％。28例胃间质瘤患者术后随访2～64个月，平均30个月，未发现肿瘤局部复发和转移。结论胃镜联合超声内镜有助于发现和诊断小的胃间质瘤，并可在术前初步判定其可切除性。在胃镜辅助定位下，行腹腔镜胃部分切除术治疗小的胃间质瘤安全、有效、预后良好。

Objective To explore the value and effect of the combination of gastroscopy, endoscopic uhrasonography （ EUS ） and laparoscopy in discovering, diagnosing and treating of small gastrointestinal stromal tumors （ GIST ） of stomach （ diameter 〈 5 cm）. Methods From August 2004 to December 2009, 43 gastric submucosal tumors were discovered by gastroscopy. 29 of them were primarily diagnosed as GIST of stomach by EUS. The diameters of tumors are from 0.89 to 3.85 cm with the average of 1.78 cm. All of them were undergone lapamscopic partial gastrectomy under the localization of gastroscope. Follow-up after operation was carried out to check for tumor recurrence and metastases. Results All operations were successfully accomplished within 35 - 90 minutes （average 55 minutes）. There were no complications and mortalities. The median postoperative hospital stay was 3.6 days （range, 3 - 5 days）. In all 29 cases, 28 cases （ 96.5 % ） were verified the diagnosis as GIST with immunohistochemistry and pathology, 1 case was schwannomas. For patients suffering from gastric stromal tumors, there was no tumor recurrence and metastases at a mean postoperative follow-up of 30 months （range, 2 - 64 months ）. Conclusions It is helpful to discover and diagnose small GIST of stomach by gastroscopy combined EUS, and predict the risk before operation. Laparoscopic partial gastrectomy under the localization of gastroscope is safe and effective and the prognosis is excellent.