腹腔镜或机器人下胃壁浆肌层环周切开加黏膜层切割闭合技术在胃特殊部位间叶源性肿瘤中的应用

Laparoscopic or robotic serosa muscular layer circumferential incision combined with mucosal layer cutting and closure for gastrointestinal mesenchymal tumors at difficult sites of the stomach

目的探讨腹腔镜或机器人下胃壁浆肌层环周切开+黏膜层切割闭合技术在胃特殊部位间叶源性肿瘤中的应用价值。方法回顾性分析2019年7月至2021年4月在河北医科大学第四医院外三科行腹腔镜或机器人下胃壁浆肌层环周切开+黏膜层切割闭合手术治疗的18例胃特殊部位间叶源性肿瘤患者的临床资料。结果 18例患者均顺利完成手术,其中7例行机器人手术,11例行腹腔镜手术,无中转开腹;肿瘤位于贲门8例,胃体小弯4例,胃窦6例;肿瘤生长方式为内生型11例,哑铃型7例。平均手术时间(99±29)min,术中出血量(10±5)ml,术后进流食时间(2.0±1.0)d,术后住院时间(4.9±1.2)d。术后病理检查示胃间质瘤11例,胃平滑肌瘤5例,胃神经鞘瘤2例,切缘均为阴性,肿瘤平均直径为(4.7±1.4)cm。中位随访时间16.5个月,无肿瘤复发、转移征象。结论腹腔镜或机器人下胃壁浆肌层环周切开+黏膜层切割闭合手术治疗胃特殊部位间叶源性肿瘤安全可行。

Objective To evaluate the use of serosa muscular layers circumferential incision combined with mucosal layer cutting and closure by laparoscopic or robotic surgery for gastrointestinal mesenchymal tumors at difficult sites of the stomach.Methods From Jul 2019 to Apr 2021,18 gastric mesenchymal tumor patients undergoing serosa muscular layers circumferential incision combined with mucosal layer cutting and closure by laparoscopic or robotic surgery at the Department of Surgery,the Fourth Hospital of Hebei Medical University were retrospectively analyzed.Results All 18 patients had successful surgery,including 7 cases of robotic surgery,11 cases of laparoscopic surgery,and there was no conversion to open surgery.Tumors were at the gastric in cardia,8 cases at the gastric body and lesser curvature in 4 cases,and at the gastric antrum in 6 cases,respectively.Eleven cases were of endogenous and 7 cases were of dumbbell type.The average operation time was(99±29)min,the intraoperative blood loss was(10±5)ml,the first time taking food per mouth was(2.0±1.0)d,and the postoperative hospital stay was(4.9±1.2)d.Pathology showed gastrointestinal stromal tumor in 11 cases,leiomyoma in 5 cases and schwannoma in 2 cases.All were with negative margins.The average tumor diameter was(4.7±1.4)cm.The median follow-up time was 16.5 months,and there was no sign of tumor recurrence or metastasis.Conclusion The serosa muscular layers circumferential incision combined with mucosal layer cutting and closure technique in laparoscopic or robotic surgery is a safe and feasible procedure for treating gastrointestinal mesenchymal tumor at difficult sites of the stomach.