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.

Are laparoscopic cholecystectomy and natural orifice transluminal endoscopic surgery gallbladder preserving cholecystolithotomy truly comparable?A propensity matched study

BACKGROUND Cholecystectomy is the preferred treatment option for symptomatic gallstones.However,another option is gallbladder-preserving cholecystolithotomy which preserves the normal physiological functions of the gallbladder in patients desiring to avoid surgical resection.AIM To compare the feasibility,safety and effectiveness of pure natural orifice transluminal endoscopic surgery(NOTES)gallbladder-preserving cholecystolithotomy vs laparoscopic cholecystectomy(LC)for symptomatic gallstones.METHODS We adopted propensity score matching(1:1)to compare trans-rectal NOTES cholecystolithotomy and LC patients with symptomatic gallstones.We reviewed 2511 patients with symptomatic gallstones from December 2017 to December 2020;517 patients met the matching criteria(NOTES,110;LC,407),yielding 86 pairs.RESULTS The technical success rate for the NOTES group was 98.9%vs 100%for the LC group.The median procedure time was 119 min[interquartile ranges(IQRs),95-175]with NOTES vs 60 min(IQRs,48-90)with LC(P<0.001).The frequency of post-operative pain was similar between NOTES and LC:4.7%(4/85)vs 5.8%(5/95)(P=0.740).The median duration of post-procedure fasting with NOTES was 1 d(IQRs,1-2)vs 2 d with LC(IQRs,1-3)(P<0.001).The median post-operative hospital stay for NOTES was 4 d(IQRs,3-6)vs 4 d for LC(IQRs,3-5),(P=0.092).During follow-up,diarrhea was significantly less with NOTES(5.8%)compared to LC(18.6%)(P=0.011).Gallstones and cholecystitis recurrence within a median of 12 mo(range:6-40 mo)following NOTES was 10.5%and 3.5%,respectively.Concerns regarding the presence of abdominal wall scars were present in 17.4%(n=15/86)of patients following LC(mainly women).CONCLUSION NOTES provides a feasible new alternative scar-free treatment for patients who are unwilling or unable to undergo cholecystectomy.This minimally invasive organ-sparing procedure both removes the gallstones and preserves the physiological function of the gallbladder.Reducing gallstone recurrence is essential to achieving widespread clinical adoption of NOTES.

Transanal minimally invasive surgery using laparoscopic instruments of the rectum:A review

Transanal minimally invasive surgery(TAMIS)was first described in 2010 as an alternative to transanal endoscopic microsurgery(TEM).The TAMIS technique can be access to the proximal and mid-rectum for resection of benign and earlystage malignant rectal lesions and also used for noncurative intent surgery of more advanced lesions in patients who are not candidates for radical surgery.TAMIS has a shorter learning curve,reduced device setup time,flexibility in instrument use,and versatility in application than TEM.Also,TAMIS shows similar results in a view of the operation time,conversion rate,reoperation rate,and complication to TEM.For these reasons,TAMIS is an easily accessible,technically feasible,and cost-effective alternative to TEM.Overall,TAMIS has enabled the performance of high-quality local excision of rectal lesions by many colorectal surgeons.As TAMIS becomes more broadly utilized such as pelvic abscess drainage,rectal stenosis,and treatment of anastomotic dehiscence,the acquisition of appropriate training must be ensured,and the continued assessment and assurance of outcome must be maintained.

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.

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.

New approaches in laparoscopic surgery for colorectal diseases: The totally laparoscopic and single-incision approaches

More than 20 years have passed since the first report of laparoscopic colectomy in 1991. Thereafter, laparoscopic surgery for the management of colorectal diseases has been widely accepted as a prevailing option because of improved cosmetic outcomes, less postoperative pain, and shorter hospital stay in comparison with open surgery. To further the principle of minimally invasive surgery, two new approaches have been developed in this rapidly evolving field. The first is the totally laparoscopic approach. Currently most of standard techniques inevitably involve an abdominalincision for retrieval of the specimen and preparation for anastomosis, which might compromise the benefits of laparoscopic surgery. The totally laparoscopic approach dispenses with this incision by combining completely intraperitoneal anastomosis with retrieval of the specimen via a natural orifice, such as the anus or the vagina. Our new and reliable technique for intraperitoneal anastomosis is also described in detail in this article. The second is the single-incision approach. While three to six ports are needed in standard laparoscopic surgery, the single-incision approach uses the umbilicus as the sole access to the abdominal cavity. All of the laparoscopic procedures are performed entirely through the umbilicus, in which the surgical scar eventually becomes hidden, achieving virtually scarless surgery. This article reviews the current status of these two approaches and discusses the future of minimally invasive surgery for colorectal diseases.

Single-incision laparoscopic cholecystectomy:Single institution experience and literature review

Single-incision laparoscopic surgery is a rapidly evolving field as a bridge between traditional laparoscopic surgery and natural orifice transluminal endoscopic surgery.We report one of the initial clinical experiences in Japan with this new technique.Four cases of gallbladder diseases were selected for this new technique.A single curved intra-umbilical 25-mm incision was made by pulling out the umbilicus.A 12-mm trocar was placed through an open approach,and the abdominal cavity was explored with a 10-mm semiflexible laparoscope.Two 5-mm ports were inserted laterally from the laparoscope port.A 2-mm mini-loop retractor was inserted to retract the fundus of the gallbladder.Dissection was performed using an electric cautery hook and an Endograsper roticulator.There were two women and two men with a mean age of 50.5 years(range:40-61 years).All procedures were completed successfully without any perioperative complications.In all cases,there was no need to extend the skin incision.Average operative time was 88.8 min.Postoperative follow-up didnot reveal any umbili-cal wound complication.Single-incision laparoscopic cholecystectomy is feasible and a promising alternative method as scarless abdominal surgery for the treatment of some patients with gallbladder disease.

Submucosal tunnel endoscopy:Peroral endoscopicmyotomy and peroral endoscopic tumor resection

Peroral endoscopic myotomy(POEM) is an innovative,minimally invasive, endoscopic treatment for esophageal achalasia and other esophageal motility disorders, emerged from the natural orifice transluminal endoscopic surgery procedures, and since the first human case performed by Inoue in 2008, showed exciting results in international level, with more than 4000 cases globally up to now. POEM showed superior characteristics than the standard 100-year-old surgical or laparoscopic Heller myotomy(LHM), not only for all types of esophageal achalasia [classical(Ⅰ), vigorous(Ⅱ), spastic(Ⅲ), Chicago Classification], but also for advanced sigmoid type achalasia(S1 and S2), failed LHM, or other esophageal motility disorders(diffuse esophageal spasm, nutcracker esophagus or Jackhammer esophagus). POEM starts with a mucosal incision, followed by submucosal tunnel creation crossing the esophagogastric junction(EGJ) and myotomy. Finally the mucosal entry is closed with endoscopic clip placement. POEM permitted relatively free choice of myotomy length and localization. Although it is technically demanding procedure, POEM can be performed safely and achieves very good control of dysphagia and chest pain. Gastroesophageal reflux is the most common troublesome side effect, and is well controllable with proton pump inhibitors. Furthermore, POEM opened the era of submucosal tunnel endoscopy, with many other applications. Based on the same principles with POEM, in combination with new technological developments, such as endoscopic suturing, peroral endoscopic tumor resection(POET), is safely and effectively applied for challenging submucosal esophageal, EGJ and gastric cardia tumors(submucosal tumors), emerged from muscularis propria. POET showed up to know promising results, however, it is restricted to specialized centers. The present article reviews the recent data of POEM and POET and discussed controversial issues that need further study and future perspectives.

Laparoscopic Submucosal Dissection for Gastrointestinal Stromal Tumor of the Stomach: A Novel Technique for Local Excision with a Minimal Curative Margin

Background: Laparoscopic wedge resection is accepted as a curative treatment for small- and mediumsized gastroin-testinal stromal tumors (GISTs) of the stomach. Conventional methods involving surgical staplers require relatively large lateral margins, which may cause deformity and postoperative dysfunction of the gastric remnant. In this study, we introduce a novel technique called laparoscopic submucosal dissection (LSD) in which the defects of the stomach are minimized and a microscopic negative margin is secured. Methods: The normal seromuscular layer of the gastric wall was dissected with a 5 mm lateral margin. Then, the submucosal tissue was divided carefully using a monopolar electrosurgical device with a curved spatula tip. Results: The operation time was 170 min, and the amount of bleeding was very small. We confirmed an intact pseudo-capsule and marginal subserosal or submucosal tissue of the tumor by histological analysis. The postoperative course was uneventful with no complications. Endoscopy showed minimal deformity of the gastric remnant. Conclusions: We think that LSD is a curative and less invasive treatment for GIST of the stomach. Further investigations are necessary to evaluate the oncological and functional outcomes of this procedure.

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。

腹腔镜内镜微创保胆术治疗胆囊息肉的meta分析

目的探讨腹腔镜内镜微创保胆手术治疗胆囊息肉的临床疗效,为临床治疗提供科学依据。方法检索PubMed、CNKI等数据库中使用腹腔镜内镜微创保胆术治疗胆囊息肉患者的临床资料,对其诊断过程、结果、有无并发症等情况采取随机对照的方法进行meta分析。结果共纳入8篇文献,研究案例1 086例。meta分析结果表明,胆囊息肉患者使用腹腔镜内镜微创保胆手术相比较于腹腔镜胆囊切除术(LC)的手术时间更短、术中出血量更少、术后第1次排气时间更短、术后并发症的发生率更低、肠蠕动恢复时间更早,差异有统计学意义。结论腹腔镜内镜微创保胆取息术较LC痛苦轻、康复快、手术并发症少,对符合适应症的患者是一种安全、有效的术式。

硬质超声胆囊内镜系统在保胆取石手术中的应用价值

目的为了准确了解胆囊结石、胆囊息肉患者胆囊、胆囊壁的病理变化,探讨硬质超声胆囊内镜系统临床应用的可行性。方法 2008年6月～11月,自主研发CHiAO(桥牌)硬质超声胆囊内镜系统(专利号:ZL200920005583.1),实施保胆取石(息肉)手术39例。术中依据硬质超声胆囊内镜系统的检查结果,用取石网、小结石吸取箱清除胆囊腔内结石、泥沙洋结石、胆泥;用推、挤、压、撕、撑、冲、吸7种手法清除胆囊黏膜下结石;对于息肉,根据硬质超声胆囊内镜系统检查所显示胆囊黏膜的完整性、胆囊壁各层次的变化、息肉的形态等信息,判定息肉的性质并决定治疗方案,良性者保留胆囊,切除息肉。取4mm×5mm胆囊组织、胆汁、结石、息肉送去做相关检查。结果 39例手术成功,平均手术时间65min,术后第1天均可下床活动,平均住院时间4d。单发结石6例,多发33例,数目1～80颗,直径2～34mm。合并胆囊息肉12例,直径1～1.5mm,数目1～20粒;黏膜下结石13例438窝,占33.33%,每例3～108窝。术中超声检查结石取净率100%。随访1～6个月,无特殊不适。硬质超声胆囊内镜系统图像质量明显优于体表超声检查,与病理诊断符号率100%。结论硬质超声胆囊内镜系统是一种新设备,为保胆取石技术及胆囊病的临床研究提供了新平台。对手术中准确了解胆囊结石(息肉)患者胆囊壁各层次的变化有重要意义。用硬质超声胆囊内镜系统进行保胆取石(息肉)是一种安全、有效、可行的新方法。

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。

胃癌微创治疗之路

外科手术是目前唯一可能治愈胃癌的手段,但传统的开腹手术通常伴随较高的并发症率和死亡率,还会对患者术后的生活质量产生较大影响。而微创外科技术由于可有效减少手术创伤,加快术后恢复,因此对于医生和患者均具有很大的吸引力,今后或将替代传统的开腹手术。目前,胃癌微创外科技术主要向着两个不同的方向发展,即内镜下肿瘤切除和腹腔镜手术。不久的将来,前哨淋巴结导航技术和机器人手术也将为胃癌治疗提供更多选择。随着各种微创技术的不断发展,胃癌患者术后的生活质量将显著改善。目前,许多有关各种微创技术的高水平临床研究正在进行当中,胃癌微创外科必将在世界范围内广为接受,并快速发展。

胆囊息肉的经皮内镜治疗

目的 :探讨胆囊息肉的治疗方法及经皮内镜胆囊息肉切除术的疗效。方法 :对 85例病人在硬膜外麻醉下行经皮内镜胆囊息肉切除术 ,先在胆囊底部作皮肤小切口 ,插入胆镜到胆囊内 ,用自制微波电极加热凝固息肉蒂部或基底部 ,切除息肉并作病理检查。术后定期随访。结果 :全部病人手术均顺利 ,手术时间 1～ 1.5h。 67例平均随访 5 .5年 (2～ 9年 ) ,结果无任何症状 ,B超检查 64例示病人胆囊功能得到完好保留 ,无结石或息肉复发。结论 :该方法是一种创伤小、效果好、并发症少的微创外科新技术 。

面向单孔腹腔镜手术应用的水平式微型磁锚定腹腔镜的设计

目的针对当前磁锚定视频器械微创性不足,提出面向单孔腹腔镜手术的水平式微型磁锚定腹腔镜设计方案。方法水平式微型磁锚定腹腔镜由壳体、水平式视频组块、定向磁体、锚定磁体、数据线及接口组成,此外还有相应的体外支持系统。试验样件在体内外进行了相关实验验证。结果水平式微型磁锚定腹腔镜可通过12 mm戳卡进入腹腔,利用“悬垂法”实现非电机驱动的30°倾角,获得目标视野且不干扰同戳卡内腔镜器械的操作。结论水平式微型磁锚定腹腔镜可提高当前单孔腹腔镜手术的微创性及操作性。

胆囊切除术两种术式术后远期发生胆囊切除术后综合征的临床研究

目的探析胆囊切除术两种术式术后远期发生胆囊切除术后综合征的临床疗效情况。方法选取2016年3月~2018年3月我院收治的60例行胆囊切除术的患者作为研究对象,随机分为对照组与治疗组,每组各30例。对照组采用传统开腹胆囊切除术疗法,治疗组采用腹腔镜胆囊切除术疗法。比较两组患者的出血量和总住院时间、手术时间和下床活动时间等各项指标,以及术后综合征发生率情况。结果治疗组患者的出血量和总住院时间、手术时间和下床活动时间情况均显著低于对照组,差异有统计学意义(P<0.05);治疗组患者出现胆囊切除术综合征的发生率为6.67%,显著低于对照组患者的30.00%,差异有统计学意义(P<0.05)。结论对行胆囊切除术的患者实施腔镜胆囊切除术治疗,其治疗效果显著优于行开腹胆囊切除术治疗的临床效果,而且还有助于术后综合征发生率的降低。

系列硬质胆囊镜的研发

中国医生提出的硬镜微创保胆取石(息肉)新概念,对于治疗胆囊结石和胆囊息肉取得较好的临床效果。目前国内外没有专门针对胆囊病手术所设计的内镜设备。专门为胆囊病手术的发展而研发的系列硬质胆囊镜及其配套附件,已经获得多项国家专利授权,并成功在国家认定的药物临床试验机构中应用手术120多例。

微创保胆取石术与腹腔镜胆囊切除术治疗胆结石的手术效果及对生活质量的影响

目的 研究微创的保胆取石的手术疗法和经过腹腔镜的胆囊切除手术对于胆结石疾病的疗效以及两种手术疗法对病人生活质量的影响.方法 采用随机表法搜集在 2014 年 1 月到 2015 年 12 月于医院诊治的患有胆结石疾病的患者共 150 例,根据手术疗法的差异将其分成两组,即研究组（ 75 例）和对照组（ 75 例）,研究组都采用微创的保胆取石手术疗法,对照组都采用经过腹腔镜的胆囊切除手术疗法.在手术后统计比较两组病人的手术时长和生活的质量情况,分析疗效.结果 研究组病人的住院时长是（2.98±0.26）天,而对照组病人的住院时长是（6.77±0.30）天,研究组病人的住院时长明显少于对照组病人（P 〈 0.05）.在手术后,研究组病人的肛门排气时长明显优于对照组病人（P 〈 0.05）.研究组病人的不良反应发生率明显低于对照组（P 〈 0.05）.在手术结束后的半年,研究组病人的 GLOI 评分是（ 110.74 ± 3.88 ）,对照组病人的 GLOI 评分是（97.33±3.09）,研究组病人的 GLOI 评分明显高于对照组病人（P 〈 0.05）.结论 采用微创的保胆取石手术疗法对胆结石疾病的疗效显著,能够大大减少病人的住院时长,降低手术的出血量,并发症比例更低,明显改善病人的生活质量,值得临床广泛开展.

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.