完全腔镜胃间质瘤切除术后整形缝合重建术的临床应用  

Clinical application of total endoscopic resection of gastric stromal tumors with cosmetic suture reconstruction

作　　者：蔡徐帆 王元宇[2] 叶再元[2] Cai Xufan;Wang Yuanyu;Ye Zaiyuan(Graduate School of Zhejiang University of Traditional Chinese Medicine,Hangzhou 330022,China;General Surgery,Department of Gastrointestinal and Pancreatic Surgery,Zhejiang Provincial People′s Hospital(Affiliated People′s Hospital,Hangzhou Medical College),Hangzhou 310014,China)

机构地区：[1]浙江中医药大学研究生院,杭州330022 [2]浙江省人民医院(杭州医学院附属人民医院)普通外科胃肠胰外科,杭州310014

出　　处：《中国医师杂志》2023年第10期1449-1452,共4页Journal of Chinese Physician

基　　金：国家卫生健康委科学研究基金-浙江省卫生健康重大科技计划(WKJ-ZJ-2201);浙江省科技厅"领雁"重大社会公益项目(2022C03099)

摘　　要：目的探讨完全腔镜胃间质瘤切除+整形缝合重建的临床疗效。方法回顾性收集2020年12月至2023年5月浙江省人民医院收治的18例完全腔镜胃间质瘤切除+整形缝合重建患者资料,分析其临床疗效。结果12例患者无任何症状,体检时发现肿瘤。18例均行完全腔镜胃间质瘤局部切除+整形缝合重建,无中转开腹手术。术后恢复流质饮食时间1~3(1.67±0.35)d,术后住院时间4~12(6.89±2.54)d,术后无并发症发生。其中低危12例,中危6例。所有病例CD117和DOG-1均阳性表达。6例中危患者中有4例行基因检测,2例c-Kit基因Lys550-Val560突变的患者给予格列卫治疗。术后1个月行胃肠造影发现胃的形态和术前形态类似,蠕动良好及排空顺畅。结论完全腔镜胃间质瘤切除+整形缝合重建胃壁连续性可以减少术后胃腔变形、贲门和幽门狭窄的发生率,具有一定的临床应用价值。Objective To investigate the clinical efficacy of total endoscopic resection of gastric stromal tumors with cosmetic suture reconstruction.Methods The data of 18 patients who underwent total laparoscopic resection of gastric stromal tumors with cosmetic suture reconstruction from December 2020 to May 2023 in Zhejiang Provincial People′s Hospital were collected retrospectively,and their clinical efficacy was analyzed.Results Twelve patients were asymptomatic and the tumor was found during physical examination.All patients underwent total endoscopic resection of gastric stromal tumors with cosmetic suture reconstruction without conversion to open surgery.The time to resume liquid diet was 1-3(1.67±0.35)days,the postoperative hospital stay was 4-12(6.89±2.54)days,and no postoperative complications occurred.Among them,12 cases were at low risk and 6 cases were at medium risk.CD117 and DOG-1 were positively expressed in all cases.Four out of six patients at medium risk underwent genetic testing,and two patients with c-Kit gene Lys550-Val560 mutation were treated with Gleevec therapy after surgery.Gastrography performed one month after surgery showed that the shape of the stomach was similar to the preoperative shape,with good motility and unimpeded emptying.Conclusions Total laparoscopic resection of gastric stromal tumors combined with cosmetic suture reconstruction can reduce postoperative gastrointestinal dilatation,esophageal and pyloric stenosis,and has a certain clinical value.

关 键 词：胃间质肿瘤 腹腔镜检查 胃切除术 消化道重建 

分 类 号：R735.2[医药卫生—肿瘤]