双镜联合技术在胃间质瘤切除术中的应用

Treatment for gastrointestinal stromal tumors by a combined laparoscopic and endoscopic approach

目的探讨腹腔镜与胃镜双镜联合手术治疗胃间质瘤的可行性和安全性。方法对2003年12月至2009年12月间采用腹腔镜与胃镜双镜联合行胃间质瘤切除手术的23例患者的临床资料进行回顾性分析，其中。18例行经胃镜定位腹腔镜胃腔外胃部分切除术、1例行经胃镜定位腹腔镜胃腔内胃部分切除术、4例行胃镜下肿瘤切除联合腹腔镜胃壁修补缝合术。结果23例手术均获成功，无中转开腹，无手术死亡和并发症。手术时间30～95min，平均（66．5±20．1）min，术中出血量1～20m，平均（12．0±17．1）ml，术后平均住院日（4．9±1．8）d。术后病理结果示：极低度风险15例、低度风险8例。随访3～75个月，无肿瘤复发和远处转移。结论腹腔镜和胃镜双镜联合手术治疗胃间质瘤是安全可行的，近期疗效令人满意，远期结果有待进一步观察。

Objective To evaluate the feasibility and security of laparoscopy combined with gastroscopy for treating gastic stromal tumors. Methods From December 2003 to December 2009, 23 patients with gastrointestinal stromal tumor of stomach were received treatment by laparoscopy combined with gastroscopy. Among them, 18 cases received laparoscopic extragastic partial gastrectomy by localization of gastroscope, one case received laparoscopic intragastic partial gastrectomy by localization and dilatation of stomach with gastroscope, four cases received gastroscopie snare cantery resection firstly and then laparsocopic repair was performed to strengthen the gastric wall. Results Operation was completed successfully within 30 - 95 rain in all 23 patients, the mean operative time was （ 66.5 ± 20.1 ）min, blood loss ranging from 1 ml to 20 ml, the mean postoperative hospital stay was （ 4.9 ± 1.8 ） days, no postoperative complication occurred. Pathologic analysis of 23 resected specimens showed： extremely low risk 15 cases, low risk 8 cases. No case of recurrence or metastasis was found during a follow-up period from 3 to 75 months. Conclusions Laparoscopy combined with gastroscopy for treating gastic stromal tumors is both feasible and safe, more minimal invasive with a favorable short-term outcome.