腹腔镜内镜联合技术切除胃肠道黏膜下肿瘤临床应用

Therapeutic value of laparoscopic and endoscopic cooperative surgery for gastrointestinal submucosaltumor resection

目的探讨腹腔镜、内镜双镜联合技术切除胃肠道黏膜下肿瘤的价值。方法回顾性分析2011年1月至2013年1月期间采用腹腔镜、内镜双镜联合技术（双镜组）切除的46例胃肠道黏膜下肿瘤患者的临床特征、手术数据、切除标本等相关指标，其中36例胃间质瘤资料另与同期19例采用单一腹腔镜技术（腹腔镜组）切除的胃间质瘤资料比较。结果双镜组与腹腔镜组手术均成功。双镜组中26例超声内镜表现为腔内型的黏膜下肿瘤采取腹腔镜辅助内镜切除方式，20例腔外型／壁间型黏膜下肿瘤则应用内镜辅助腹腔镜切除的手术方式：两型患者在切除的肿瘤大小、术中出血量、术后住院天数项目差异具有统计学意义，前者均小于后者。双镜组中1例术后第2天发生急性穿孔紧急修补，其余患者术后无并发症出现。对于胃间质瘤患者，双镜组（36例）与腹腔镜组（19例）比较，肿瘤最大径／切除标本最大径[（0．88±0．14）比（0．65±0．15）]、术后住院天数[（6．42±1．96）d比（9．26±3．46）d]的差异均有统计学意义。结论腹腔镜、内镜联合技术切除胃肠道黏膜下肿瘤安全可行，切除精准，保证切缘阴性同时尽可能少切除正常组织，并可对术中的出血、穿孔闭合不全等及时进行补救。

Objective To evaluate the feasibility and safety of laparoscopic and endoscopic coopera- tive surgery （LECS） for gastrointestinal submucosal tumors （SMTs）. Methods Clinical characteristics and resected specimens of 46 patients with gastrointestinal SMTs treated by LECS from January 2011 to January 2013 （ LECS group）, and data of 19 gastric gastrointestinal stromal tumors （GIST） treated by laparoscopie resection as a control group （LS group） were retrospectively analysed. Results In LECS group, 26 cases with intra-luminal mass received laparoscopy-assisted endoscopic resection, 20 cases with extra-luminal mass received endoscopy-assisted laparoscopie resection. The tumor size, estimated blood loss, and hospital stay after surgery showed significant differences between the intra-luminal type group and the extra-luminal type group, the former being smaller. Perforation occurred in one case, and there was no complication in others. As for gastric GIST, the mean ratio of the longest diameter of tumor divided by the longest diameter of the surgical specimen in LECS group and LS group were 0. 88 ± 0. 14 and 0. 65± 0. 15, respectively. Also, there was significant difference in hospital stay after surgery between two groups （ 6.42 ±1.96 ） days vs （9. 26 ± 3.46） days. Conclusion Compared with single laparoscopic resection, LECS for dissection of gastrointestinal submucosal tumors is both feasible and safe with reasonable operation times, less bleeding, rela- tively small resections of healthy gastrointestinal wall.