腹腔镜下胃后壁间质瘤“开关”式切除术  

Switch method for laparoscopic resection of gastrointestinal stromal tumor on the posterior wall of the stomach

作　　者：余涛[1] 吴琪芳[1] 方宏才[1] 

机构地区：[1]九江学院附属医院肝胆外科,332000

出　　处：《中华腔镜外科杂志（电子版）》2017年第1期43-45,共3页Chinese Journal of Laparoscopic Surgery(Electronic Edition)

摘　　要：目的探讨腹腔镜下胃后壁间质瘤"开关"式切除术的临床应用价值。方法患者全身麻醉成功后取平卧位,采用五孔法,结合术前内镜下肿瘤定位,腹腔镜下超声刀切开肿瘤对应胃前壁3~5 cm,助手牵开胃前壁,显露肿瘤,术者沿肿瘤周围1~2 cm正常胃黏膜开始超声刀裁剪,完整切除肿瘤后,3-0可吸收线间断缝合胃后壁及切开的胃前壁(也可采用内镜切割缝合器Endo-GIA闭合),切除的标本装入标本袋后经观察孔扩大后完整取出。结果该术式下29例患者均完成腹腔镜下手术,无一例中转开腹,手术时间(108.5±25.6)min,术中出血量(50.4±12.4)ml,肿瘤周围切缘均在1~2 cm且完整规则,肿瘤大小2.5~5.9 cm,术后排气时间(2.0±0.6)d,术后1 d拔除胃管,术后2 d进流食,术后无一例并发症,术后住院时间(6.7±1.1)d;结合术后免疫组化回报,其中13例为极低复发风险、12例为低复发风险、4例为中度复发风险;术后随访12个月,无一例复发转移。结论腹腔镜下胃后壁间质瘤"开关"式切除术,简单、易行,且符合无瘤手术的原则,值得临床实践中进一步探索与推广。Objective To explore the clinical value of ＂Switch＂ method for laparoscopic resection of gastrointestinal stromal tumor on the posterior wall of the stomach. Methods The patients were treated with supine anesthesia, and the 5-hole method was used. Combined with the preoperative endoscopic tumor localization, the surgeon cut the tumor corresponding to the anterior wall of the stomach 3-5 cm with the ultrasonic knife, then the assistant retract the anterior wall of the stomach and exposed the tumor. The surgeon cut the tissue along the tumor 1-2 cm normal gastric mucosa with the ultrasonic knife, complete resection of the tumor, the 3-0 absorbable line interrupted suture the stomach wall and incision of the anterior wall of the stomach （Endo-GIA can also be used for closing ）, removal of specimens loaded specimen bag after the expansion of the observation hole after the complete removal. Results All the 29 patients underwent the laparoscopic operation, none of them were converted to laparotomy. The average time of operation was （108.5 ± 25.6）rain, the average blood loss was （50.4 ± 12.4）ml,the margin of tumor was 1-2 cm, postoperative mean exhaust time was （2.0 ±0.6）days. The gastric tube was removed on the first day after operation and the fluid was taken on the second day. There was no complication after operation. The mean postoperative hospital stay was （ 6.7 ± 1. 1 ） days. Immunohistochemieal results showed, 13 cases with very low recurrence risk, 12 cases with low recurrence risk, 4 cases with moderate recurrence risk. All patients were followed up for 12 months and none relapsed. Conclusions Switch method for laparoscopic resection of gastrointestinal stromal tumor on the posterior wall of the stomach is simple and easy to perform. It is in line with the principle of tumor-free operation, worthy of further exploration and promotion in the clinical practice.

关 键 词：腹腔镜手术 胃肠道间质瘤 开关式切除术 

分 类 号：R735[医药卫生—肿瘤]