微创手术治疗胃胃肠间质瘤62例分析

Clinical analysis of 62 cases of minimally invasive surgery for gastric gastrointestinal tumors

目的探讨胃胃肠间质瘤（GIST）的微创手术治疗体会。方法回顾性分析扬州大学附属泰州市人民医院2008年至2014年收治的行腹腔镜胃楔形切除、内镜定位辅助腹腔镜胃楔形切除（双镜联合切除）、腹腔镜辅助部分和全胃切除及内镜下切除术的62例胃GIST患者的临床资料。结果 62例患者,肿瘤直径2∽12 cm;其中行腹腔镜胃楔形切除31例,内镜定位辅助腹腔镜胃楔形切除22例,腔镜辅助远端胃切除3例、近端胃切除2例、全胃切除1例,内镜下切除3例。所有标本病理切缘为阴性,平均手术时间87 min,平均术中出血79 ml,平均胃肠功能恢复时间39 h,术后平均住院时间8.2 d,未发生吻合口瘘、吻合口狭窄、腹腔感染或切口感染等并发症。根据NIH危险度分级标准,中危、高危11例;术后服用伊马替尼,随访2∽60个月,未发现肿瘤局部复发和转移病例。结论胃GIST行微创切除创伤小、恢复快,安全可靠,疗效肯定。

Objective To evaluate the efficacy and safety of minimally invasive surgery for gastric gastrointestinal stromal tμmors （GIST）. Methods Clinical data of 62 patients with gatric gastrointestinal stromal tμmors from 2008 to 2014 were analyzed retrospectively in the Taizhou People＇s Hospital of Yangzhou University. Results The tμmor size varied from 2 to 12 cm in 62 patients . Surgical procedures included 31 laparoscopic gastric wedge resections, 22 endoscopic-assisted laparoscopy resections, 6 laparoscopic-assisted partial or total gastreetomy, and 3 endoscopic submucosal dissection. All cases exhibited a pathologically negative margin. The mean operative time was 87 min, and the mean estimated amount of blood loss was 79 ml. The mean postoperative bowl function recovery time was 39 hours. The mean postoperative hospital stay was 8.2 days. There were no postoperative complications such as anastomosis leakage, anastomosis stenosis,incisional or intraabdominal infection. According to NIH risk classification, 11 patients were at an intermediate or high risk and were received adjuvant treatment with imatinib. After a follow-up period from 2 to 60 months,no recurrence, metastasis or death was found. Conclusions Minimally invasive surgery is safe and feasible for treating primary gastric GIST.