腹腔镜胃胃肠间质瘤外翻切除术的临床价值

The study of laparoscopic transgastric tumor-everting resection in gastrointestinal stromal tumor

目的探讨腹腔镜胃胃肠间质瘤(gastrointestinal stromal tumor,GIST)外翻切除术的临床价值。方法回顾性分析2013年7月至2015年7月在中山大学附属第一医院因胃GIST接受腹腔镜下肿瘤切除手术的27例患者临床病例资料,将患者分为两组,其中腹腔镜胃GIST外翻切除术(laparoscopic transgastric tumor-everting resection,LTTR)组8例和腹腔镜胃楔形切除术(laparoscopic wedge resection,LWR)组19例,对比两组手术时间、手术出血量、标本切缘、切除正常胃组织面积、术后并发症发生率、术后肛门排气时间、术后进食半流质时间、术后住院天数和随访情况。结果术中LTTR组的手术时间较LWR延长[(70±9)分钟vs.(56±8)分钟,P<0.001]。LTTR组出血量与LWR组比较无统计学差异[(39±12)ml vs.(38±14)ml,P=0.942]。LTTR组的正常胃组织切除面积明显少于LWR组[(33.0±5.6)cm^2 vs.(119.3±41.6)cm^2,P<0.001]。术后两组均无胃出血、胃穿孔、切缘均无肿瘤残留、无胃排空障碍等情况发生。术后两组肛门排气时间[(2.4±0.5)天vs.(2.3±0.5)天,P=0.842]、进食半流时间[(3.5±0.5)天vs.(3.0±0.8)天,P=0.07]比较无明显差异。患者中位随访时间17个月(4~31个月),两组均无肿瘤局部复发和远处转移,无患者死亡。结论腹腔镜胃肿瘤外翻切除术可以安全有效地运用于无黏膜溃疡改变的胃GIST患者,其优点是能够最大限度的保留正常胃壁组织,能有效减少胃腔狭窄、梗阻发生率,是腹腔镜胃楔形切除术的有效补充术式。

Objective To investigate the clinical value of laparoscopic transgastric tumor-everting resection for gastrointestinal stromal tumor（GIST）. Methods The clinical data of 27 cases of gastric GIST underwent laparoscopic tumor resection during from July 2013 to July 2015 in our hospital were analyzed retrospectively. All patients were divided into two groups,laparoscopic trans-gastric tumor-everting resection（LTTR） group（n =8） and laparoscopic wedge resection（LWR） group（n =19）. The operation time,bleeding volume, pathological examination of the specimen margin, removal area of normal stomach, anal exhaust time, time to retrieve semi-liquid diet, disease recurrence and survival rate were compared between the two groups. Results The operation time of LTTR group was longer than that of LWR group [（70±9）min vs.（56±8） min, P〈0.001 ]. There was no significant difference in bleeding volume between two groups.The resection area of normal gastric tissue in LTTR group was significantly less than that in LWR group[（33.0±5.6）cm^2vs.（119.3±41.6）cm^2,P〈0.001 ]. There were no stomach bleeding, gastric perforation, no tumor residual in resection margin and postoperative gastric emptying disorder in both two groups. The anal exhaust time [（2.4 ±0.5）d vs.（2.3 ±0.5）d, P =0.842 ] and feeding time [（3.5 ±0.5）d vs.（3.0 ±0.8）d,P=0.07 ] were no significant differences between two groups. The median follow-up time was 17 months（4~31 months）. No recurrence was observed and all cases survived. Conclusions Laparoscopic transgastric tumor-everting resection used for the patients with gastric GIST without mucosal ulcer is safe and effective. It can maximize the preservation of normal gastric tissue and effectively reduce the incidence of gastric lumen stenosis and obstruction. It is an effective supplement surgery for laparoscopic wedge resection of the stomach for GIST patients.