腹腔镜下切除胃间质瘤25例报告

Laparoscopic Resection for Gastric Stromal Tumor: a Report of 25 Cases

目的探讨腹腔镜下个体化治疗胃间质瘤的可行性和安全性。方法2008年7月～2011年11月对25例胃间质瘤行腹腔镜下个体化切除。1例位于贲门，直径6．5cm行腹腔镜辅助近端胃切除术；1例位于胃窦前壁，直径4．5cm，行腹腔镜辅助远端胃切除术；16例位于胃底及胃体，直径2．0—5．5cm，肿瘤充分游离后行腹腔镜下楔形切除术；7例胃后壁腔内型肿瘤，直径2．8～5．0cm，行腹腔镜经胃肿瘤外翻切除术。结果25例均在腹腔镜下完整切除肿瘤。平均手术时间84min（53～165min），平均术中出血量48ml（20—140m1）。标本切缘未见肿瘤残留，术后病理及免疫组化检查证实为间质瘤，CDll7阳性25例，CD34阳性21例。术后除1例出现胃动力功能障碍，余胃肠功能恢复良好，无胃出血、狭窄及胃漏。术后平均住院8d（6—13d）。24例随访3～36个月（中位随访时间15个月），生存良好，无复发、转移。结论腹腔镜下胃间质瘤个体化的胃部分切除术可行、安全。

Objective To evaluate the feasibility and safety of laparoscopic resection for gastric stromal tumor. Methods Twenty-five patients with gastric stromal tumors underwent laparoseopic resection from July 2008 to November 2011, including I ease of laparoseopy-assisted proximal gastreetomy （LAPG） with a diameter of 6. 5 cm, 1 case of laparoscopy-assisted distal gastrectomy （LADG） with a diameter of d. 5 cm, 16 cases of laparoscopic wedge resection （LWR） with a diameter of 2.0 - 5.5 cm and 7 cases of laparoscopic transgastric tumor-everting resection（LTGTER） with a diameter of 2. g - 5.0 cm. Results Laparoscopic resection of gastric stromal tumors was performed successfully in all cases. The operative time ranged from 53 to 165 min （average, 84 rain） and intraoperative blood loss ranged from 20 to 140 ml （average, 48 ml）. No residual tumor was found by specimen examination. Gastric stromal tumor was diagnosed by pathological examination and immunohistological staining. CD117 was positive in 25 cases and CD34 in 21 cases. All eases had smooth postoperative recovery except for 1 ease of gastric motility dysfunction. No stomach bleeding, stenosis or leakage occurred. The postoperative hospital stay ranged from 6 to 13 d （average, 8 d）. Twenty-four eases were followed up for 3 - 36 months （median, 15months） without recurrence or metastasis. Conclusion Personalized laparoscopic partial gastrectomy is a safe and feasible procedure for the treatment of gastric stromal tumor.