腹腔镜下胃底黏膜下肿瘤切除术

摘要

目的 评价腹腔镜下胃腔外胃底楔形切除术的可行性与安全性.方法 总结分析2000年9月至2006年12月行腹腔镜下胃底切除术的84例患者的临床资料.该术式采用4孔法,手术主要步骤包括肿瘤定位、网膜游离、胃底和脾上极分离、食管贲门连接处(ECJ)显露以及用内视镜直线切割缝合器楔形切割胃底等.结果 患者平均年龄59岁(32～78岁).平均肿瘤直径(4.2±1.3)cm;肿瘤边缘距离ECJ 1.1～3.0 cm.84例手术均获成功,手术时间(62.6±8.9)min;术中出血(86.2±8.1)ml.无病灶遗漏,亦无并发症和手术中转.术后平均住院(5.6±0.5)d.66例患者于术后36 h内恢复胃肠功能,并开始进食和下床活动.肿瘤与切缘的距离:与ECJ距离0.7～2.5 cm[(1.4±0.5)cm];与另三面距离2.5～6.0 cm[(4.1±1.0)cm].84例中,平滑肌瘤29例,各型间质瘤51例,神经纤维瘤4例.平均随访(51.0±4.3)个月,无复发和转移发生.结论 腹腔镜胃腔外胃底楔形切除术对胃底,尤其是后壁邻近ECJ黏膜下肿瘤是安全、简便和有效的,可避免腹腔污染、脾脏损伤以及术后食管狭窄的发生;同时,胃的切除范围也不受限.%Objective To investigate the feasibility and safety of extraluminal laparoscopic wedge resection(ELWR)in treating submucosal tumors in the gastric fundus.Methods Clinical data of 84 patients underwent ELWR for submucosal tumors in the gastric fundus between September 2000 and December 2006 were reviewed and analyzed retrospectively.The four-portal operation procedures were carried out as follows:localization of the tumor.dissection of the omentum.mobilization of the gastric fundus and the upper polar of spleen,exposure of ECJ,and resection of the gastric fundus with Endo GIA.Results The patients included 53 males and 31 females,age ranged from 32 to 78 years(mean,59 years).The mean tumor diameter was (4.2±1.3)cm.The distance from the tumor edge to the ECJ was 1.1-3.0 cm.The operations were successful in all the 84 patients,with a mean operation time of(62.6±8.9)min and mean operative blood 1088 of(86.2±8.1)ml.No apparent tumor focus was left.No operation was convened to open surgery,and no significant postoperative complications occurred.The mean post-operative hospital stay wag(5.6±0.5)days.The gastrointestinal function recovered within 36 h after operation in 66 cases (78.6%),and the patients returned to normal activity and restored oral feeding.The distance between the tumor and the resection margin was 0.7-2.5 cm from the ECJ[mean,(1.4±0.5)cm],and 2.5-6.0 cm from the other three sides[mean,(4.1±1.0)cm].Of the 84 cases,29 cases were diagnosed with leiomyoma,51 cases different types of stromal tumor and 4 cages neurofibroma.The mean follow-up duration was(51.0±4.3)months,no recurrence or metastasis was found in the mean time.Conclusions ELWR is a safe,simple and beneficial procedure for submucosal tumors in the gastric fundus,especially in the posterior wall near the ECJ.It avoids intraperitoneal infection,possible splenic injury and postoperative esophageal stenosis.In addition.the resection scope is not limited.