腹腔镜手术治疗胃和小肠胃肠间质瘤疗效分析

Efficacy analysis of laparoscopic surgery for primary local gastric and intestinal gastrointestinal stromal tumors

目的探讨原发局限性胃和小肠胃肠间质瘤（GIST）腹腔镜手术切除的可行性和短期效果。方法回顾性分析2010年10月至2013年4月间在中山大学附属第一医院接受腹腔镜手术治疗的20例胃GIST和6例小肠GIST患者的临床病理资料。结果26例患者中行手辅助腹腔镜胃GIST切除3例，其余23例均行腹腔镜辅助切除手术，无一例中转开腹。根据肿瘤部位和生长方式，行胃局部切除术18例，远端胃部分切除2例，小肠部分切除6例。肿瘤直径（4．5±1．6）cm，手术时间（96．0±28．2）min，术中出血量（49．6±38．6）ml。术后胃肠功能恢复时间（2．3±0．7）d，术后住院时间（6．8±1．9）d。术后吻合口出血1例，保守治疗治愈。术后病理按照改良NIH标准显示，极低度恶性危险（极低危）1例（3．8％），低危13例（50．0％），中危9例（34．6％），高危3例（11．5％）。术后随访3～32（中位数15）月，未发现复发或死亡病例。结论原发局限性胃或小肠GIsT腹腔镜切除创伤小、恢复快，短期效果满意。

Objective To investigate the feasibility and short-term efficacy of laparoscopic resection of primary local gastric and intestinal gastrointestinal stromal tumors （GIST）. Methods Clinicopathological data of 26 patients with GIST, 20 located at the stomach and 6 at the intestine, undergoing laparoscopic complete resection from October 2010 to April 2013 were retrospectively analyzed. Results Hand-assisted laparoscopic surgery was performed in 3 patients with gastric GIST, while the other 23 underwent regular laparoscopic surgery. All the procedures were performed successfully without conversion to open operation. According to tumor location and growth types, gastric local resection was performed in 18 cases, distal gastrectomy in 2 cases and intestinal segmental resection in all 6 cases of intestinal GIST. The mean diameter of tumor was （4.5＋1.6） cm. The mean operational time was （96.2~28.2） rain, with a mean blood loss of （49.6~38.6） ml. Postoperative bowel function recovery time was（2.3~0.7） d and the length of postoperative hospital stay was （6.8~ 1,9） d. Bleeding from gastrointestinal tract developed in 1 patient after resection of intestinal GIST. Postoperative pathology indicated very low risk of GIST in 1 （3.8%）, low risk in 13 （50.0%）, intermediate in 9 （34.6%） and high risk in 3 （11.5%） patients, respectively. After a follow-up ranging form 3 to 32 months, no recurrence or death was found. Conclusion Laparoscopic surgery of primary local GISTs from stomach or intestine is safe and feasible in selected patients, with less invasiveness, rapid recovery, and favorable short-term outcomes.