直径大于5cm胃间质瘤腹腔镜切除的临床分析

Laparoscopic resection for gastric stromal tumors with sizes larger than 5 cm

目的探讨对直径≥5cm胃间质瘤行腹腔镜手术治疗的临床疗效、安全性及可行性。方法回顾性分析2010年1月1日至2017年6月31日浙江大学附属邵逸夫医院和浙江省人民医院腹腔镜手术治疗的肿瘤直径≥5cm胃间质瘤3l例患者的临床及随访资料。结果3l例患者均顺利完成手术，其中2例中转开腹。平均肿瘤直径（7．2±0．5）cm，平均手术时间为（127±12）min，术中平均出血量为（83±25）ml，术后平均排气时间（2．2±0．8）d，平均首次进食流质时间（2．4±1．4）d，术后平均住院时间（5．5±1．5）d。中位随访时间25个月。1例患者在术后41个月出现肝转移，予口服甲磺酸伊马替尼治疗24个月，截止随访终点仍存活。结论对肿瘤直径≥5cm的胃间质瘤患者行腹腔镜手术是安全和可行的。

Objective To investigate the treatment efficacy, feasibility and safety of laparoscopic resection for gastric gastrointestinal stromal tumors （GISTs） larger than 5 cm. Methods The clinical data of 31 patients who underwent laparoscopic resection of large gastric GISTs between Jan 2010 and Jun 2017 at Sir Run Run Shaw Hospital and People＇s Hospital of Zhejiang Province were retrospectively analyzed. Results All operations were successful. Two patients were converted to open surgery. The mean tumor size was （7.2±0. 5） cm. The mean operation time was （127 ± 12） min, intraoperative blood loss was （83 ±25 ） ml. The first flatus time was （2. 2 ± 0. 8 ） days, the first diet resumption time was （ 2.4± 1.2 ） days, and the median postoperative hospital stay was （5.5 ±1.5 ） days. The median follow-up time was 25 months. One patient developing liver metastasis 41 months after primary resection received oral mesylate imatinib therapy for 24 months and was still alive at the last follow-up. One patient died of lung cancer 33 months after primary operation without recurrence of gastric GIST. Conclusions Laparoscopic surgery for gastric GIST larger than 5 cm on laparoscopicaly accessible location is feasible and safe.