腹腔镜胃胃肠间质瘤弧形切除术疗效分析

Efficacy analysis of laparoscopic curve resection for gastric gastrointestinal stromal tumor

目的探讨在腹腔镜胃胃肠间质瘤（GIST）手术中使用弧形切割吻合器行胃弧形切除的可行性及安全性。方法回顾性分析2015年1-12月间在首都医科大学附属北京朝阳医院普通外科接受腹腔镜胃GIST弧形切除术的19例患者的临床资料。术中弧形切割吻合器在距离肿瘤至少0．5cm处做胃弧形切除，如弧形切割吻合器初次激发未能完整切断胃壁，则再使用直线切割吻合器离断残余胃壁。结果全组19例病例均于腹腔镜下顺利完成手术，无中转开腹及术中严重并发症的发生。14例（73．7％）使用弧形切割吻合器一次激发完整切断肿瘤所在胃壁，余5例（26.3％）患者加用直线切割吻合器切断残余胃壁。手术时间为50-100（71．8±12．7）min，术中出血量20-50（33．6±7．4）ml。术后胃肠功能恢复时间1-4（2．4±0．9）d，术后住院时间为5-9（6．84-1．1）d。全组术后均未出现切口感染、胃排空障碍、胃漏及出血。术后病理示：肿瘤长径1．5-5．5（2．94-1．1）cm，切缘0．5～2．0（1．24-0．4）cm，镜下切缘均未见肿瘤细胞残留；术后病理证实19例均为GIST．按原发GIST切除术后危险度分级标准进行分级：极低危8例（42．1％）、低危5例（26．3％）、中危5例（26．3％）、高危1例（5．3％）。6例中、高危患者术后接受伊马替尼辅助治疗。术后随访5—16（中位数10）月，所有病例均未发现肿瘤局部复发及远处转移。结论腹腔镜胃GIST手术中使用弧形切割吻合器行胃弧形切除安全可行，近期疗效满意。

Objective To evaluate the feasibility and safety of curved cutter stapler in laparoscopic curve resection for gastric gastrointestinal stromal tumor（GIST）. Methods A retrospective clinical study was carried out with the clinical data of 19 cases of gastric GIST, who received laparoscopic curve resection with the curved cutter stapler during the period between January 2015 and December 2015 in Department of General Surgery, Beijing Chaoyang Hospital, Capital Medical University. Curved cutter stapler was used intraoperatively to run curve resection for stomach, at least 0.5 cm away from the tumor outer margin. If the curved cutter stapler could not completely cut off the gastric wall at first time, the linear cutter stapler would be used secondly to cut off the remaining gastric wall. Results All the cases were successfully performed under laparoscopy, without conversion to open surgery and the occurrence of severe complications. Fourteen （73.7%） patients received complete transection by the first curved cutter stapler, the other 5 （26.3%） cases accepted complete transection by the second linear cutter stapler. The operative time ranged from 50 to 100 （71.8 ± 12.7） minutes, the blood loss ranged from 20 to 50 （33.6 ± 7.4） ml, the postoperative exhaust time ranged from 1 to 4 （2.4 ± 0.9） days, the postoperative hospital stay ranged from 5 to 9 （6.8 ± 1.1） days. There was no patient suffered from incision infection, delayed gastric emptying, anastomotic leakage and anastomotic bleeding. The postoperative pathological examination confirmed that all the cases were GIST. The tumor length ranged from 1.5 to 5.5（2.9 ± 1.1） cm, the resection margin ranged from 0.5 to 2.0（1.2 ± 0.4） cm and all the patients had negative resection margins. Of the 19 cases, 8 （42.1%） were classified as very low risk, 5（26.3%） as low risk, 5（26.3%） as moderate risk and 1（5.3%） as high risk according to the National Institute of Health classification. Six patients with moderate and high risk were treated with imatinib. In the follow-up time of 5 to 16 months （mean 10 months） after operation, no distant metastasis and local recurrence occurred in all the cases. Conclusion The application of curved cutter stapler in laparoscopie curve resection for GIST is safe and feasible with good short-term efficacy.