腹腔镜下胃肠道间质瘤“包饺子式”切除术50例报告

Laparoscopic "Making-dumplings" Resection of Gastrointestinal Stromal Tumor:Report of 50 Cases

目的探讨腹腔镜下胃肠道间质瘤(gastrointestinal stromal tumor,GIST)"包饺子式"切除术的疗效及可行性。方法 2010年7月~2015年2月行腹腔镜下GIST"包饺子式"切除术,采用缝线悬吊后,直线切割闭合器夹闭,类似包饺子,距离肿瘤边缘2 cm以上切除肿瘤。结果手术时间(95.8±34.2)min,术中出血量(40.2±17.9)ml。50例均完整切除肿瘤,切缘在2 cm以上,术后病理切缘未见肿瘤细胞,病理诊断为GIST,肿瘤直径5例>5 cm,23例2~5 cm,22例<2 cm,无淋巴结转移,20例极低危,17例低危,7例中危,6例高危。50例术后平均随访24个月(8-36个月),1例术后3个月腹腔大网膜转移,再次手术切除,其余49例经胃镜、腹部B超或CT提示无复发和转移。结论腹腔镜下GIST"包饺子式"切除术可行,效果良好,值得进一步推广应用。

Objective To explore the clinical effect and feasibility of laparoscopic ＂ making-dumplings＂ resection for gastrointestinal stromal tumor（GIST）. Methods Fifty patients with GIST underwent laparoscopic ＂ making-dumplings＂ resection from July 2010 to February 2015. We used suture to overhang the tumor,then sealed the lesion with linear cutting stapler like ＂making-dumplings＂,finally resected it with a more than 2 cm edge. Results The operation time was（95. 8 ± 34. 2） min and the intraoperative blood loss was（40. 2 ± 17. 9） ml. The tumor body of resected specimen was intact,and the resection margin was more than 2 cm. GIST was diagnosed by pathological examination and immunohistological staining. There were 5 cases of tumor diameter 5 cm,23 cases between 2 cm and 5 cm,and 22 cases less than 2 cm. No residual tumor or lymph node metastasis was found.According to newly revised NIH risk grading standards,there were 20 cases of very low risk,17 cases of low risk,7 cases of moderate risk,and 6 cases of high risk. The mean follow-up time after operation was 24 months（range,8-36 months）. There was one case of omentum metastasis after 3 months operation which was reoperated,and the remaining 49 cases had no recurrence or metastasis under gastroscopy,ultrasonography and CT scanning. Conclusion Laparoscopic ＂ making-dumplings＂ resection for GIST is feasible and effective,being worthy of further clinical application.