目的探討經(jīng)臍單孔腹腔鏡聯(lián)合胃鏡治療微小胃間質(zhì)瘤(gastric stromal tumors, GIST)的可行性和臨床療效。 方法回顧性分析我院2010年10月至2011年5月期間行經(jīng)臍單孔腹腔鏡聯(lián)合胃鏡治療微小GIST 30例患者的臨床資料。 結(jié)果30例病灶直徑(1.0±0.2) cm(0.5~2.0 cm),術(shù)后病理檢查均證實(shí)為極低危險(xiǎn)程度GIST。 24例在單孔腹腔鏡輔助下成功完成內(nèi)鏡黏膜下剝離術(shù)(endoscopic submucosal dissection,ESD); 3例因ESD術(shù)中發(fā)生胃壁穿孔而改行內(nèi)鏡全層切除術(shù)(endoscopic full-thickness resection, EFR),其中2例繼續(xù)在單孔下完成穿孔修補(bǔ)術(shù),1例于左上腹壁另加一 Trocar,在雙孔下完成穿孔修補(bǔ)術(shù); 另3例因ESD剝離瘤體困難,改行胃局部切除術(shù),其中2例繼續(xù)在單孔下完成手術(shù),1例在雙孔下完成手術(shù)。 ESD成功率為80.0%(24/30),經(jīng)臍部單孔完成率為93.3%(28/30)。手術(shù)時(shí)間(87.5±10.3) min (45~150 min)。 全組術(shù)后(4.3±0.5) d (3~8 d)出院。術(shù)后隨訪期3~7個(gè)月(平均4.6個(gè)月),均無病變復(fù)發(fā)。 結(jié)論經(jīng)臍部單孔腹腔鏡聯(lián)合胃鏡治療微小GIST是安全可行的,早期療效令人滿意。
引用本文: 劉雁軍,張抒,孫曉斌,李云濤,姚欣敏,夏鄉(xiāng),曹齊常,侯康. 經(jīng)臍單孔腹腔鏡聯(lián)合胃鏡治療微小胃間質(zhì)瘤30例臨床分析. 中國普外基礎(chǔ)與臨床雜志, 2011, 18(11): 1209-1211. doi: 復(fù)制
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1. | Fletcher CD, Berman JJ, Corless C, et al. Diagnosis of gastrointestinal stromal tumors: A consensus approach [J]. Int J Surg Pathol, 2002, 10(2): 8189. |
2. | Nilsson B, Bümming P, MeisKindblom JM, et al. Gastrointestinal stromal tumors: the incidence, prevalence, clinical course, and prognostication in the preimatinib mesylate era—a populationbased study in western Sweden [J]. Cancer, 2005, 103(4): 821829. |
3. | Liu YJ, Yang Z, Hao LS, et al . Synchronous incidental gastrointestinal stromal and epithelial malignant tumors [J]. Word J Gastroenterol, 2009, 15(16): 19212048. |
4. | Miettien M, Majidi M, Lasota J. Pathology and diagnostic criteria of gastrointestinal stromal tumors (GISTs): a review [J]. Enr J Cancer, 2002, 38(5): 3951. |
5. | Tornóczky T, Kvér E, Pajor L. Frequent occurrence of low grade cases among metastatic gastrointestinal stromal tumors [J]. J Clin Pathol, 2003, 56(5): 363367. |
6. | Miettinen M, ElRifai W, Sobin LH, et al. Evaluation of malignancy and prognosis of gastrointestinal stromal tumors: a review [J]. Hum Pathol, 2002, 33(5): 478483. |
7. | Tanaka J, Oshima T, Hori K, et al. Small gastrointestinal stromal tumor of the stomach showing rapid growth and early metastasis to the liver [J]. Dig Endosc, 2010, 22(4): 354356. |
8. | 鄭成竹, 李際輝. 胃間質(zhì)瘤的診斷和微創(chuàng)治療 [J]. 中國普外基礎(chǔ)與臨床雜志, 2004, 11(3): 199200. |
9. | 羅國德, 龔加慶, 張林, 等. 腹腔鏡胃部分切除術(shù)治療胃間質(zhì)瘤22例 [J]. 中國普外基礎(chǔ)與臨床雜志, 2010, 17(10): 10141016. |
10. | Trcoveanu E, Dimofte G, Vasilescu A, et al. Laparoscopic management of gastrointestinal stromal tumours [J]. Acta Chir Belg, 2010, 110(3): 295302. |
11. | 鐘蕓詩, 陳巍峰, 秦新裕. 內(nèi)鏡黏膜下剝離術(shù)治療消化道固有肌層腫瘤 [J].中華消化內(nèi)鏡雜志, 2008, 25(1): 2225. |
12. | Canes D, Desai MM, Aron M, et al. Transumbilical singleport surgery: evolution and current status [J]. Eur Urol, 2008, 54(5): 10201029. |
13. | Hiki N, Yamamoto Y, Fukunaga T, et al . Laparoscopic and endoscopic cooperative surgery for gastrointestinal stromal tumor dissection [J]. Surg Endosc, 2008, 22(7): 17291735. |
14. | Wang L, Ren W, Fan CQ, et al . Fullthickness endoscopic resection of nonintracavitary gastric stromal tumors: a novel approach [J]. Surg Endosc, 2011, 25(2): 641647. |
15. | Zhou PH, Yao LQ, Qin XY, et al . Endoscopic fullthickness resection without laparoscopic assistance for gastric submucosal tumors originated from the muscularis propria [J]. Surg Endosc, 2011, 25(9): 29262931. |
- 1. Fletcher CD, Berman JJ, Corless C, et al. Diagnosis of gastrointestinal stromal tumors: A consensus approach [J]. Int J Surg Pathol, 2002, 10(2): 8189.
- 2. Nilsson B, Bümming P, MeisKindblom JM, et al. Gastrointestinal stromal tumors: the incidence, prevalence, clinical course, and prognostication in the preimatinib mesylate era—a populationbased study in western Sweden [J]. Cancer, 2005, 103(4): 821829.
- 3. Liu YJ, Yang Z, Hao LS, et al . Synchronous incidental gastrointestinal stromal and epithelial malignant tumors [J]. Word J Gastroenterol, 2009, 15(16): 19212048.
- 4. Miettien M, Majidi M, Lasota J. Pathology and diagnostic criteria of gastrointestinal stromal tumors (GISTs): a review [J]. Enr J Cancer, 2002, 38(5): 3951.
- 5. Tornóczky T, Kvér E, Pajor L. Frequent occurrence of low grade cases among metastatic gastrointestinal stromal tumors [J]. J Clin Pathol, 2003, 56(5): 363367.
- 6. Miettinen M, ElRifai W, Sobin LH, et al. Evaluation of malignancy and prognosis of gastrointestinal stromal tumors: a review [J]. Hum Pathol, 2002, 33(5): 478483.
- 7. Tanaka J, Oshima T, Hori K, et al. Small gastrointestinal stromal tumor of the stomach showing rapid growth and early metastasis to the liver [J]. Dig Endosc, 2010, 22(4): 354356.
- 8. 鄭成竹, 李際輝. 胃間質(zhì)瘤的診斷和微創(chuàng)治療 [J]. 中國普外基礎(chǔ)與臨床雜志, 2004, 11(3): 199200.
- 9. 羅國德, 龔加慶, 張林, 等. 腹腔鏡胃部分切除術(shù)治療胃間質(zhì)瘤22例 [J]. 中國普外基礎(chǔ)與臨床雜志, 2010, 17(10): 10141016.
- 10. Trcoveanu E, Dimofte G, Vasilescu A, et al. Laparoscopic management of gastrointestinal stromal tumours [J]. Acta Chir Belg, 2010, 110(3): 295302.
- 11. 鐘蕓詩, 陳巍峰, 秦新裕. 內(nèi)鏡黏膜下剝離術(shù)治療消化道固有肌層腫瘤 [J].中華消化內(nèi)鏡雜志, 2008, 25(1): 2225.
- 12. Canes D, Desai MM, Aron M, et al. Transumbilical singleport surgery: evolution and current status [J]. Eur Urol, 2008, 54(5): 10201029.
- 13. Hiki N, Yamamoto Y, Fukunaga T, et al . Laparoscopic and endoscopic cooperative surgery for gastrointestinal stromal tumor dissection [J]. Surg Endosc, 2008, 22(7): 17291735.
- 14. Wang L, Ren W, Fan CQ, et al . Fullthickness endoscopic resection of nonintracavitary gastric stromal tumors: a novel approach [J]. Surg Endosc, 2011, 25(2): 641647.
- 15. Zhou PH, Yao LQ, Qin XY, et al . Endoscopic fullthickness resection without laparoscopic assistance for gastric submucosal tumors originated from the muscularis propria [J]. Surg Endosc, 2011, 25(9): 29262931.