腹腔镜联合胃镜胃部分切除治疗胃黏膜下肿物

摘要

Objective To evaluate the feasibility of laparoscopic and endoscopic cooperative partial gastrectomy, a minimally invasive surgery, in treating gastric submucosa lesion. Methods We retrospectively analyzed 63 patients [34 women and 29 men, aged (52. 8 ±18. 1) years (range: 14 to 78 years) ] who had undergone laparoscopic and endoscopic cooperative partial gastrectomy with preserving cardia and pylorus for gastric submucosal tumor in the past 6 years. All of the patients were followed up for 2-69 months ( average 35 months). The clinicopathological data, surgical approaches, and follow-up results were analyzed. Results The surgery was successfully performed in all these 63 patients, among whom 61 were assisted by endoscopy. The most common symptom was dyspepsia. The mean distance from the lesions locating at fundus or antrum to cardia or pylorus was (2. 9 ±1. 1) cm. The minimum distance from tumor edge to cardia was 1cm. The diseases included gastrointestinal stromal tumor ( n = 54 ) , carcinoid tumors ( n = 3 ) , ectopic pancreas ( n = 2 ) , li-poma ( n = 2 ) , and leiomyoma ( n = 2 ). The tumor size ranged from 0. 8 to 8. 2 cm, with 44 lesions (69. 8% ) less than 2cm. Forty-five lesions (71. 4% ) were located at fundus, 12 ( 19. 0% ) at body, and 6(9. 6% ) at antrum. No recurrence or death was noted during follow-up. Conclusions Laparoscopic and endoscopic cooperative partial gastrectomy is feasible for treating gastric submucosal tumor. Endoscopy is useful for intraopera-tive localization and supporting, and therefore is especially helpful for preserving cardia and pylorus.%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.