New-style laparoscopic and endoscopic cooperative surgery for gastric stromal tumors

AIM: To evaluate the feasibility and safety of a new style of laparoscopic and endoscopic cooperative surgery (LECS), an improved method of laparoscopic intragastric surgery (LIGS) for the treatment of gastric stromal tumors (GSTs). METHODS: Six patients were treated with the newstyle LECS. Surgery was performed according to the following procedures: (1) Exposing and confirming the location of the tumor with gastroscopy; (2) A laparoscopy light was placed in the cavity using the trocar at the navel, and the other two trocars penetrated both the abdominal and stomach walls; (3) With gastroscopy monitoring, the operation was carried out in the gastric lumen using laparoscopic instruments and the tumor was resected; and (4) The tumor tissue was removed orally using a gastroscopy basket, and puncture holes and perforations were sutured using titanium clips. RESULTS: Tumor size ranged from 2.0 to 4.5 cm (average 3.50 ± 0.84 cm). The operative time ranged from 60 to 130 min (average 83.33 ± 26.58 min). Blood loss was less than 20 mL and hospital stay ranged from 6 to 8 d (average 6.67 ± 0.82 d). The patients were allowed out of bed 12 h later. A stomach tube was inserted for 72 h after surgery, and a liquid diet was then taken. All cases had single tumors which were completely resected using the new-style LECS. No postoperative complications occurred. Pathology of all resected specimens showed GST: no cases of implantation or metastasis were found.CONCLUSION: New-style LECS for GSTs is a quick, optimized, fast recovery, safe and effective therapy.

Laparoscopic and endoscopic cooperative surgery for gastric tumors: Perspective for actual practice and oncological benefits

Laparoscopic and endoscopic cooperative surgery(LECS) is a surgical technique that combines laparoscopic partial gastrectomy and endoscopic submucosal dissection. LECS requires close collaboration between skilled laparoscopic surgeons and experienced endoscopists. For successful LECS, experience alone is not sufficient. Instead, familiarity with the characteristics of both laparoscopic surgery and endoscopic intervention is necessary to overcome various technical problems. LECS was developed mainly as a treatment for gastric submucosal tumors without epithelial lesions, including gastrointestinal stromal tumors(GISTs). Local gastric wall dissection without lymphadenectomy is adequate for the treatment of gastric GISTs. Compared with conventional simple wedge resection with a linear stapler, LECS can provide both optimal surgical margins and oncological benefit that result in functional preservation of the residual stomach. As technical characteristics, however, classic LECS involves intentional opening of the gastric wall, resulting in a risk of tumor dissemination with contamination by gastric juice. Therefore, several modified LECS techniques have been developed to av-oid even subtle tumor exposure. Furthermore, LECS for early gastric cancer has been attempted according tothe concept of sentinel lymph node dissection. LECS is a prospective treatment for GISTs and might become a future therapeutic option even for early gastric cancer. Interventional endoscopists and laparoscopic surgeons collaboratively explore curative resection. Simultaneous intraluminal approach with endoscopy allows surgeons to optimizes the resection area. LECS, not simple wedge resection, achieves minimally invasive treatment and allows for oncologically precise resection. We herein present detailed tips and pitfalls of LECS and discuss various technical considerations.

Reduction effect of bacterial counts by preoperative saline lavage of the stomach in performing laparoscopic and endoscopic cooperative surgery

AIM: To investigate the effects of gastric lavage with 2000 mL of saline in laparoscopic and endoscopic cooperative surgery.

Laparoscopic and endoscopic cooperative surgery for full-thickness resection and sentinel node dissection for early gastric cancer

The endoscopic submucosal dissection(ESD)technique has become the gold standard for submucosal tumors that have negligible risk of lymph node metastasis(LNM),due to its minimal invasiveness and ability to improve quality of life.However,this technique is limited in stage T1 cancers that have a low risk of LNM.Endoscopic full thickness resection can be achieved with laparoscopic endoscopic cooperative surgery(LECS),which combines laparoscopic gastric wall resection and ESD.In LECS,the surgical margins from the tumor are clearly achieved while performing organ-preserving surgery.To overcome the limitation of classical LECS,namely the opening of the gastric wall during the procedure,which increases the risk of peritoneal tumor seeding,non-exposed endoscopic wall-inversion surgery was developed.With this full-thickness resection technique,contact between the intra-abdominal space and the intragastric space was eliminated.

Non-exposed endoscopic wall-inversion surgery with one-step nucleic acid amplification for early gastrointestinal tumors:Personal experience and literature review

BACKGROUND Laparoscopic and endoscopic cooperative surgery is a safe,organ-sparing surgery that achieves full-thickness resection with adequate margins.Recent studies have demonstrated the safety and efficacy of these procedures.However,these techniques are limited by the exposure of the tumor and mucosa to the peritoneal cavity,which could lead to viable cancer cell seeding and the spillage of gastric juice or enteric liquids into the peritoneal cavity.Non-exposed endoscopic wallinversion surgery(NEWS)is highly accurate in determining the resection margins to prevent intraperitoneal contamination because the tumor is inverted into the visceral lumen instead of the peritoneal cavity.Accurate intraoperative assessment of the nodal status could allow stratification of the extent of resection.One-step nucleic acid amplification(OSNA)can provide a rapid method of evaluating nodal tissue,whilst nearinfrared laparoscopy together with indocyanine green can identify relevant nodal tissue intraoperatively.AIM To determine the safety and feasibility of NEWS in early gastric and colon cancers and of adding rapid intraoperative lymph node(LN)assessment with OSNA.METHODS The patient-based experiential portion of our investigations was conducted at the General and Oncological Surgery Unit of the St.Giuseppe Moscati Hospital(Avellino,Italy).Patients with early-stage gastric or colon cancer(diagnosed via endoscopy,endoscopic ultrasound,and computed tomography)were included.All lesions were treated by NEWS procedure with intraoperative OSNA assay between January 2022 and October 2022.LNs were examined intraoperatively with OSNA and postoperatively with conventional histology.We analyzed patient demographics,lesion features,histopathological diagnoses,R0 resection(negative margins)status,adverse events,and follow-up results.Data were collected prospectively and analyzed retrospectively.RESULTS A total of 10 patients(5 males and 5 females)with an average age of 70.4±4.5 years(range:62-78 years)were enrolled in this study.Five patients were diagnosed with gastric cancer.The remaining 5 patients were diagnosed with early-stage colon cancer.The mean tumor diameter was 23.8±11.6 mm(range:15-36 mm).The NEWS procedure was successful in all cases.The mean procedure time was 111.5±10.7 min(range:80-145 min).The OSNA assay revealed no LN metastases in any patients.Histologically complete resection(R0)was achieved in 9 patients(90.0%).There was no recurrence during the follow-up period.CONCLUSION NEWS combined with sentinel LN biopsy and OSNA assay is an effective and safe technique for the removal of selected early gastric and colon cancers in which it is not possible to adopt conventional endoscopic resection techniques.This procedure allows clinicians to acquire additional information on the LN status intraoperatively.

Laparoscopic-endoscopic cooperative surgery for gastric submucosal tumors

AIM:To assess the feasibility,safety,and advantages of minimally invasive laparoscopic-endoscopic cooperative surgery(LECS)for gastric submucosal tumors(SMT).METHODS:We retrospectively analyzed 101 consecutive patients,who had undergone partial,proximal,or distal gastrectomy using LECS for gastric SMT at Peking Union Medical College Hospital from June 2006to April 2013.All patients were followed up by visit or telephone.Clinical data,surgical approach,pathological features such as the size,location,and pathological type of each tumor;and follow-up results were analyzed.The feasibility,safety and effectiveness of LECS for gastric SMT were evaluated,especially for patients with tumors located near the cardia or pylorus.RESULTS:The 101 patients included 43(42.6%)menand 58(57.4%)women,with mean age of 51.2±13.1 years(range,14-76 years).The most common symptom was belching.Almost all(n=97)patients underwent surgery with preservation of the cardia and pylorus,with the other four patients undergoing proximal or distal gastrectomy.The mean distance from the lesion to the cardia or pylorus was 3.4±1.3 cm,and the minimum distance from the tumor edge to the cardia was 1.5 cm.Tumor pathology included gastrointestinal stromal tumor in 78 patients,leiomyoma in 13,carcinoid tumors in three,ectopic pancreas in three,lipoma in two,glomus tumor in one,and inflammatory pseudotumor in one.Tumor size ranged from 1 to8.2 cm,with 65(64.4%)lesions<2 cm,32(31.7%)>2 cm,and four>5 cm.Sixty-six lesions(65.3%)were located in the fundus,21(20.8%)in the body,10(9.9%)in the antrum,three(3.0%)in the cardia,and one(1.0%)in the pylorus.During a median follow-up of 28 mo(range,1-69 mo),none of these patients experienced recurrence or metastasis.The three patients who underwent proximal gastrectomy experienced symptoms of regurgitation and belching.CONCLUSION:Laparoscopic-endoscopic cooperative surgery is feasible and safe for patients with gastric submucosal tumor.Endoscopic intraoperative localization and support can help preserve the cardia and pylorus during surgery.

Laparoscopic and endoscopic co-operative surgery for nonampullary duodenal tumors

AIM To assess the safety and feasibility of laparoscopic and endoscopic co-operative surgery(LECS) for early nonampullary duodenal tumors.METHODS Twelve patients with a non-ampullary duodenal tumor underwent LECS at our hospital. One patient had two mucosal lesions in the duodenum. The indication for this procedure was the presence of duodenal tumors with a low risk for lymph node metastasis. In particular, the tumors included small(less than 10 mm) submucosal tumors(SMT) and epithelial mucosal tumors, such as mucosal cancers or large mucosal adenomas with malignant suspicion. The LECS procedures, such as full-thickness dissection for SMT and laparoscopic reinforcement after endoscopic submucosal dissection(ESD) for epithelial tumors, were performed for the 13 early duodenal lesions in 12 patients. Here we present the short-term outcomes and evaluate the safety and feasibility of this new technique.RESULTS Two SMT-like lesions and eleven superficial epithelial tumor-like lesions were observed. Seven and Six lesions were located in the second and third parts of the duodenum, respectively. All lesions were successfully resected en bloc. The defect in the duodenal wall was manually sutured after resection of the duodenal SMT. For epithelial duodenal tumors, the ulcer bed was laparoscopically reinforced via manual suturing after ESD. Intraoperative perforation occurred in two out of eleven epithelial tumor-like lesions during ESD; however, they were successfully laparoscopically repaired. The median operative time and intraoperative estimated blood loss were 322 min and 0 mL, respectively. Histological examination of the tumors revealed one adenoma with moderate atypia, ten adenocarcinomas, and two neuroendocrine tumors. No severe postoperative complications(Clavien-Dindo classification grade Ⅲ or higher) were reported in this series, but minor leakage secondary to pancreatic fistula occurred in one patient.CONCLUSION LECS can be a safe and minimally invasive treatment option for non-ampullary early duodenal tumors.

Novel and safer endoscopic cholecystectomy using only a flexible endoscope via single port

AIM: To apply the laparoscopic and endoscopic cooperative surgery concept, we investigated whether endoscopic cholecystectomy could be performed more safely and rapidly via only 1 port or not.METHODS: Two dogs(11 and 13-mo-old female Beagle) were used in this study. Only 1 blunt port was created, and a flexible endoscope with a tip attachment was inserted between the fundus of gallbladder and liver. After local injection of saline to the gallbladder bed, resection of the gallbladder bed from the liver was performed. After complete resection of the gallbladder bed, the gallbladder was pulled up to resect its neck using the Ring-shaped thread technique. The neck of the gallbladder was cut using scissor forceps. Resected gallbladder was retrieved using endoscopic net forceps via a port. RESULTS: The operation times from general anesthetizing with sevoflurane to finishing the closure of the blunt port site were about 50 min and 60 min respectively. The resection times of gallbladder bed were about 15 min and 13 min respectively without liver injury and bleeding at all. Feed were given just after next day of operation, and they had a good appetite. Two dogs are in good health now and no complications for 1 mo after endoscopic cholecystectomy using only a flexible endoscope via one port.CONCLUSION: We are sure of great feasibility of endoscopic cholecystectomy via single port for human.

腹腔镜-内镜联合手术治疗早期胃癌初期病例技术分析

目的:回顾性分析既往接受双镜联合手术的早期胃癌患者,评价该手术治疗早期胃癌的可行性。方法:回顾性收集2013年5月至2024年4月于北京大学肿瘤医院接受双镜联合手术的早期胃癌患者。手术方式包括内镜下黏膜切除(endoscopic submucosal dissection,ESD)联合腹腔镜淋巴结活检、经典腹腔镜-内镜联合手术(laparoscopic and endoscopic cooperative surgery,LECS)及其改良术式。收集患者临床病理特点、术后恢复指标、并发症及生存结局纳入分析。结果:共纳入9例患者,中位年龄64岁,男性6例(66.7%),女性3例(33.3%)。所有患者活检病理均为分化型胃癌。5例(55.6%)患者手术方式为ESD联合腹腔镜淋巴结活检,4例(44.4%)患者行腹腔镜辅助内镜全层切除及前哨淋巴结切检,平均麻醉时间(351.2±91.4)min,平均出血量(34.4±15.1)mL。术后出现3例(33.3%)并发症,包括1例胃排空障碍(CD2级),1例腹腔感染(CD2级),1例消化道穿孔(CD3级)。中位随访时间52个月,所有患者无复发及死亡。结论:双镜联合手术治疗早期胃癌具有可行性,其肿瘤学安全性仍需要进一步研究证实。LECS技术、适应证人群选择和前哨淋巴结切检准确率是进一步研究的重点。

Present situation of minimally invasive surgical treatment for early gastric cancer

Minimally invasive surgery is a kind of surgical operation,which is performed by using professional surgical instruments and equipment to inactivate,resect,repair or reconstruct the pathological changes,deformities and wounds in human body through micro-trauma or micro-approach,in order to achieve the goal of treatment,its surgical effect is equivalent to the traditional open surgery,while avoiding the morbidity of conventional surgical wounds.In addition,it also has the advantages of less trauma,less blood loss during operation,less psychological burden and quick recovery on patients,and these minimally invasive techniques provide unique value for the examination and treatment of gastric cancer patients.Surgical minimally invasive surgical techniques have developed rapidly and offer numerous options for the treatment of early gastric cancer(EGC):endoscopic mucosal resection(EMR),underwater EMR(UEMR),endoscopic submucosal dissection(ESD),endoscopic full-thickness resection(EFTR),endoscopic submu-cosal excavation(ESE),submucosal tunnel endoscopic resection,laparoscopic and endoscopic cooperative surgery(LECS);Among them,EMR,EFTR and LECS technologies have a wide range of applications and different modific-ations have been derived from their respective surgical operations,such as band-assisted EMR(BA-EMR),conven-tional EMR(CEMR),over-the-scope clip-assisted EFTR,no-touch EFTR,the inverted LECS,closed LECS,and so on.These new and improved minimally invasive surgeries are more precise,specific and effective in treating different types of EGC.

Perforation associated with endoscopic submucosal dissection for duodenal neoplasm without a papillary portion

AIM To investigate predictors of perforation after endoscopic resection(ER) for duodenal neoplasms without a papillary portion.METHODS This was a single-center, retrospective, cohort study conducted between April 2003 and September 2014. A total of 54 patients(59 lesions) underwent endoscopic mucosal resection(EMR)(n = 36) and endoscopic submucosal dissection(ESD)(n = 23). Clinical features, outcomes, and predictors of perforation were investigated.RESULTS Cases of perforation occurred in eight(13%) patients(95%CI: 4.7%-22.6%). Three ESD cases required sur-gical management because they could not be repaired by clipping. Delayed perforation occurred in two ESD cases, which required surgical management, although both patients underwent prophylactic clipping. All patients with perforation who required surgery had no postoperative complications and were discharged at anaverage of 13.2 d after ER. Perforation after ER showed a significant association with a tumor size greater than20 mm(P = 0.014) and ESD(P = 0.047).CONCLUSION ESD for duodenal neoplasms exceeding 20 mm may be associated with perforation. ESD alone is not recom-mended for tumor treatment, and LECS should be con-sidered as an alternative.

Combined endoscopy/laparoscopy/percutaneous transhepatic biliary drainage, hybrid techniques in gastrointestinal and biliary diseases

In recent years,a wide range of gastrointestinal endoscopy techniques have been developed,such as endoscopic submucosal dissection(ESD)and endoscopic retrograde cholangiopancreatography(ERCP).Although ESD and ERCP have an important role in gastrointestinal and biliary diseases,each technique has its limitations.Hybrid techniques that combine endoscopic and surgical procedures have emerged that have the advantages of different procedures and negate their limitations at the same time.Laparoscopic endoscopic cooperative surgery and modified laparoscopic endoscopic cooperative surgery combine ESD and laparoscopic techniques to resect submucosal tumors with minimum resection area.Air leak test by intraoperative endoscopy can effectively identify a mechanically insufficient anastomosis and decrease the complication rate.The rendezvous technique that combines percutaneous transhepatic biliary drainage and endoscopy can be performed as a rescue approach for the treatment of biliary obstruction,stenosis and bile duct injuries.For patients with simultaneous presence of stones in the gallbladder and the common bile duct,the laparoendoscopic rendezvous technique can perform ERCP and laparoscopic cholecystectomy at the same time and reduces the risk of pancreatic injury caused by ERCP.Biliobiliary and bilioenteric anastomosis using magnetic compression anastomosis is another choice for biliary obstruction.The most common used approach to deliver the magnets is by percutaneous-peroral tract.Laparoscopicassisted ERCP is a safe and highly effective therapy for patients who develop biliary diseases after Roux-en-Y gastric bypass surgery.

腹腔镜联合内镜手术治疗胃肿瘤的研究进展

腹腔镜联合内镜手术是一种结合了腹腔镜胃切除术和内镜下黏膜剥离术的术式,通过充分利用两种术式的优点,尽量做到以最小的损伤切除肿瘤。这一术式最早被用于切除胃间质瘤,而后随着这一类术式的不断发展,演变出更多更完善的手术术式,手术的适应证也越来越广。而具体选择何种术式,需要根据患者的具体情况进行精确化,个性化的选择。本文简述了常见的手术流程及适应证,并对各手术方式进行比较,以期望能帮助临床医生准确地选择合适的手术方式。

早期胃癌微创治疗进展

近年来,随着我国癌症早筛政策的推广和人民健康体检意识的提高,早期胃癌的比例在不断提高,其微创化治疗方式也逐渐受到重视。早期胃癌的手术治疗先后经历了传统开腹手术、腹腔镜手术、内镜手术、双镜联合手术等发展阶段,正在朝着更加微创精准的治疗方向发展。目前,对于淋巴结转移风险较低的早期胃癌,推荐进行内镜下治疗,包括内镜下黏膜切除术和内镜下黏膜剥离术。而对于存在一定淋巴结转移风险的早期胃癌,目前指南推荐行腹腔镜D1/D1+/D2根治术。近年来,大量研究聚焦于探索进一步优化早期胃癌微创治疗的新术式,比如双镜联合精准确定原发灶范围并保留更多胃壁正常组织,从而避免消化道重建;前哨淋巴结示踪及活检技术减少淋巴结清扫范围等。在本文中,笔者通过查阅国内外相关指南及文献,并结合临床实践经验,对早期胃癌微创治疗的发展历程、现状及前景进行探讨。

双镜联合技术在治疗困难部位胃间质瘤的临床效果研究

目的探讨双镜联合技术治疗困难部位胃间质瘤的安全性、临床效果及预后情况。方法回顾性分析2015年1月至2021年12月湖州市中心医院收治的85例胃间质瘤患者的临床资料,根据手术方式的不同将其分为双镜联合组(43例)和开腹手术组(42例)。比较两组患者的围手术期相关指标、术后并发症发生情况及随访情况。结果双镜联合组患者的术中出血量显著少于开腹手术组,术后疼痛评分显著低于开腹手术组,术后首次排气时间、术后进流食时间及总住院时间均显著短于开腹手术组(P<0.05);两组患者的手术时间比较差异无统计学意义(P>0.05);双镜联合组患者的总并发症发生率显著低于开腹手术组(χ^(2)=4.435,P=0.035)。随访10~73个月,两组患者均未见复发、远处转移及死亡。结论双镜联合技术应用于困难部位胃间质瘤手术安全、有效,可减少术中出血和术后并发症,缩短患者的恢复时间,值得临床推广应用。

腹腔镜联合胃镜胃部分切除治疗胃黏膜下肿物

目的探讨双镜联合行保留贲门、幽门的胃部分切除术治疗黏膜下肿物的安全性、可行性和必要性。方法回顾性分析我院因胃黏膜下肿物行腹腔镜微创手术的住院患者63例,对患者临床病理特征、手术方法、短期临床结局及长期预后进行分析。结果 63例患者均实施了腹腔镜手术,成功保留了贲门及幽门,其中男性29例、女性34例,年龄14～78岁,平均(52.8±18.1)岁。63例手术中,61例由胃镜辅助完成,其中52例病灶浆膜面无法探及,需胃镜术中定位。除胃体外,胃底、胃窦部肿物51例,距贲门或幽门平均(2.9±1.1)cm,最近距离贲门1cm。病理结果显示,63例患者肿物直径0.8～8.2cm;其中44例(69.8%)肿物<2cm,19例(30.2%)≥2cm。病变分布:胃底45例(71.4%)、胃体12例(19.0%)和胃窦6例(9.6%)。术后病理确诊胃肠间质瘤54例、类癌3例、异位胰腺2例、脂肪瘤2例、平滑肌瘤2例。平均随访35个月,无复发或死亡。患者无烧心、嗳气等症状,营养状况及生活质量良好。结论腹腔镜胃部分切除术是胃黏膜下肿物的优选治疗方式,胃镜实时定位及支撑作用为保留贲门和幽门提供了重要技术支持。

双镜联合技术在胃间质瘤中的应用效果

目的探讨双镜联合技术治疗胃间质瘤的安全性和有效性。方法回顾性分析2014年1月至2016年6月安徽医科大学第一附属医院治疗的胃间质瘤患者136例临床资料,其中采用双镜联合治疗患者44例、单纯胃镜治疗患者42例、单纯腹腔镜治疗患者50例。比较3种治疗方式的手术时间、术中出血量、术后胃肠道功能恢复时间、术后下床活动时间、术后住院时间,以及术后并发症发生率和肿瘤复发情况。结果所有患者均手术顺利,无术后死亡病例,所有患者术后随访均未见复发。双镜联合组操作时间、术中出血量、术后胃肠道功能恢复时间、术后下床活动时间、术后住院时间均短于或少于单纯腹腔镜组(P<0.05),单纯胃镜组肿瘤直径、操作时间、术后胃肠道功能恢复时间、术后下床活动时间、术后住院时间均短于或少于单纯腹腔镜组(P<0.05)。结论对于直径较小的胃间质瘤,单纯胃镜切除是最佳方案。双镜联合技术更适合治疗直径在10 cm以内较大的胃间质瘤,其操作安全可行,且具有定位准确,创伤小、术后恢复快的特点,近期疗效令人满意,但其远期疗效仍需进一步随访。

早期大肠癌双镜联合治疗与腹腔镜治疗的疗效比较

目的:通过与腹腔镜治疗的有效性和安全性对比,探讨内镜和腹腔镜联合应用在治疗早期大肠癌中的作用.方法:对95例确诊为早期大肠癌且病变范围在3.0-5.0 cm患者,50例行内镜和腹腔镜双镜联合治疗(双镜组),45例行腹腔镜切除治疗(腹腔镜组),对比分析两组的手术时间、术中并发症、术中出血量、术后住院时间、术后并发症、复发和转移率.结果:双镜组与腹腔镜组比较,手术时间短(80.5 min±21.3 min vs 85.2 min±25.8 min,P<0.05),术中出血量少(69.0 mL±25.9 mL vs 80.1 mL±36.7 mL,P<0.05),术后均无并发症发生,术后住院时间分别为7.4 d±1.8 d及7.2 d±1.9 d,无明显差异(P>0.05).两组随访18 mo均未见复发和转移.结论:病变范围在3.0-5.0 cm的早期大肠癌,双镜联合治疗与腹腔镜手术疗效相似,但创伤小、恢复快,更安全.

胃黏膜下肿瘤微创治疗的进展

胃黏膜下肿瘤经常于胃镜检查中被发现,给诊断及治疗带来了挑战.最值得讨论的胃黏膜下肿瘤为间质瘤,因其为胃肠道最常见的间质性肿瘤.由于胃肠道间质瘤存在潜在恶性的可能,治疗局限胃间质瘤的主要目标是达到边缘阴性的切除,这是一种获得完全治疗的有效方法.微创治疗已经广泛应用在切除胃肠道黏膜下肿瘤方面.随着内镜技术的迅猛发展,内镜下切除为胃黏膜下肿瘤的治疗提供了不同的方案.有些专家还提出了内镜与腔镜的联合治疗.除此以外,机器人切除黏膜下肿瘤也成为可能.本文主要介绍微创治疗胃黏膜下肿瘤的进展.

内镜和腹腔镜联合应用在治疗较大大肠侧向发育型肿瘤中的临床价值

目的:探讨内镜和腹腔镜联合应用在治疗较大大肠侧向发育型肿瘤(laterally spreading tumor,LST)中的临床价值.方法:回顾性总结21例确诊为LST且直径>3cm患者内镜和腹腔镜双镜联合治疗效果.结果:21例双镜联合治疗患者,根据术前电子肠镜活检病理结果、靛胭脂染色及超声内镜诊断,分别行腹腔镜辅助内镜切除术9例、内镜辅助腹腔镜手术7例,其中1例追加腹腔镜根治术以及内镜和腹腔镜同时治疗5例.术中切除标本送检快速冰冻切片病理检查证实:低级别上皮瘤变者13例(61.9%),高级别上皮瘤变者7例(33.3%),癌变者1例(4.8%),病变以结节混合型为主9例(42.9%),其次为扁平隆起型8例(38.1%).术后平均随访18 mo,无1例转移、复发.结论:对直径>3 cm的LST,采用内镜和腹腔镜双镜联合治疗,对病灶定位准确,创伤小,治疗安全、彻底、复发率低.