内镜辅助腹腔镜剥离切除术治疗胃窦体固有肌层肿瘤的初步应用

Combined laparoscopic and endoscopic submucosal resection of gastric antrum-body tumors originated from the muscularis propria

目的评价一种新的胃镜腹腔镜联合方法治疗胃窦体固有肌层肿瘤的临床疗效。方法2013年1月至2014年4月，选择8例胃窦体固有肌层肿瘤，术前超声内镜诊断肿物起源固有肌层，黏膜层良好，胃窦体前壁4例、后壁2例、胃体小网膜囊内1例、胃体大网膜下1例。病变大小1．5～3．5cm，平均（2．4±0．7）cm。先在腹腔镜下分离显露病变，后在内镜进行病变黏膜下注射，最后由腹腔镜剥离切除病变并保留黏膜。随访观察手术情况和治疗效果。结果所有患者成功完成内镜辅助腹腔镜剥离切除，无出血、感染和死亡病例。术后病理证实间质瘤6例，神经纤维瘤2例。所有患者随访6个月后胃黏膜未见异常，胃壁蠕动正常，无复发。结论内镜辅助腹腔镜剥离切除技术是胃窦体固有肌层肿物重要的安全有效的治疗方法，具有操作简便、损伤小、并发症少的优点。

Objective To investigate clinical effect of combined laparoscopic and endoscopic sub- mucosal resection for the gastric antrumody tumors originated from the muscularis propria. Methods A total of 8 patients with gastric antrum-body tumors originated from the muscularis propria were treated by combined laparoscopic and endoscopic submucosal resection from Jan 2013 to Apt 2014. All patients were diagnosed as having gastric antrum-body tumors originated from the muscularis propria by preoperative endoscopic ultrasonography. Endoscopy showed that the surface mucosa of tumors were normal in all patients. Tumors were found in the gastric antrum-body front wall in 4 cases, and in the back wall in 2 cases, and in the lesser omental bursa in 1 case, and in the greater omental bursa in 1 case. The tumors size was from 1.5 to 3. 5 cm, averaging （2. 4± 0. 7） cm. The therapeutic procedure included three phases. The lesion was first exposed with laparoscopy. Then, the fluid was injected into the submucosa in the part of tumor by endosco- py. Finally the tumor was resected by laparoscopy. These patients were followed up and analyzed retrospectively. Results Combined laparoscopic and endoscopic submucosal resection was successfully performed in all patients. All tumors were resected completely. Sever bleeding, infection or death were not found in any patients. Postoperative pathology and immunohistochemistry staining confirmed 6 stromal tumors and 2 neuro- fibroma. All patients were followed up for 6 months, and there was no recurrent case. Gastric mucosa and function were normal in all patients. Conclusion Combined laparoscopic and endoscopic submucosal resection is a simple, safe and effective method for gastric antrum-body tumors originated from the muscularis propria, and leads to little complication.