经脐单切口腹腔镜治疗胃间质瘤的不同手术方式选择

Exploration of Different Managements for Resection of Gastric Stromal Tumor by Single Incision Laparoscopic Surgery

目的总结针对不同肿瘤直径、不同部位的胃间质瘤在经脐单切口腹腔镜下的处理方法。方法回顾性分析2009年12月至2014年2月期间于我院接受经脐单切口腹腔镜手术治疗的34例胃间质瘤患者的一般资料、术中处理及术后恢复情况。结果本组34例患者均顺利完成经脐单切口腹腔镜手术,其中行胃楔形切除27例,远端胃大部切除6例,远端胃大部切除联合脏器切除1例。所有肿瘤切除完整,平均肿瘤大小3.4 cm（0.6～10.0 cm）。危险度分级为极低危险度9例,低危险度17例,中危险度6例,高危险度2例。肿瘤位于胃底部9例,胃大弯侧6例,胃小弯侧7例,胃前壁2例,胃后壁2例,贲门下方3例,胃窦部4例,肿瘤侵袭周围脏器1例。全组术中无中转为多孔及开腹手术病例。除1例患者术后出现腹腔内出血及1例患者出现切口感染外,其余患者术后恢复顺利。全组无吻合口漏及梗阻病例发生。所有病例目前随访3～49个月,平均25个月,随访期间未见复发及死亡病例。结论根据本组有限的病例资料初步得出,经脐单切口腹腔镜治疗胃间质瘤安全、可行,需要根据肿瘤大小及位置选择合适的手术方式。

Objective To summarize the procedure oftransumbilical single incision laparoscopic surgery （SILS） with conventional laparoscopic instruments for different tumor diameter and different site of gastric stromal tumor. Method The clinical data, intraoperative procedure, and postoperative recovery of 34 patients with gastric stromal tumor from December 2009 to February 2014 in this hospital were analyzed retrospectively. Results The transumbilical SILS was performed successfully in all the 34 patients. Among these patients, the wedge resection of stomach was perfor- med in 27 patients, distal subtotal gastrectomy was performed in 6 patients, distal subtotal gastrectomy complicated with multivisceral resection was performed in 1 patient. The pathology confirmed that the diameter of tumors was from 0. 6 cm to 10. 0 cm （average 3.4 cm）. The resection margins were tumor free. The risk assessment showed that tumors with extremely low risk were in 9 cases, low risk were in 17 cases, intermediate risk were in 6 cases, high risk were in 2 cases. During surgery, 9 tumors were located on the fundus of stomach, 6 tumors on the gastric greater curvature, 7 tumors on the gastric lesser curvature, 2 tumors on the anterior and posterior wall of the stomach respectively, 3 tumors on the cardia below, 4 tumors on the gastric antrum, tumor invaded the surrounding organs in 1 case. There was no conversion to open or conventional laparoscopic surgery. No intraoperative or postoperative complications were experi- enced in all the patients except one was postoperative intraperitoneal bleeding and one was incision infection. All the patients were followed for an average of 25 months （range 3-49 months）, there was no evident recurrence of disease. Coneluslons The transumbilical SILS for gastric stromal tumor is a feasible and safe technique when performed by an experienced laparoscopic surgeon. The suitable procedure of SILS should be selected for gastric stromal tumor according their different size and location.