腹腔镜手术治疗直径大于5cm的胃肠间质瘤患者的疗效分析

摘要

目的:探讨腹腔镜手术切除直径大于5 cm的胃肠间质瘤(GIST)的可行性和中短期疗效.方法:回顾性分析26例接受腹腔镜手术治疗的直径大于5 cm的胃GIST患者的临床资料,观察患者术后恢复情况、并发症和中短期预后.结果:26例患者均行腹腔镜手术切除,无1例中转开腹.根据肿瘤部位和生长方式行腹腔镜全胃切除1例,腹腔镜近端胃切除2例,腹腔镜远端胃切除3例,其余20例均行腹腔镜下胃局部切除术.26例患者肿瘤平均直径为(5.94±1.28)cm,平均手术时间为(84.23±27.02)min,术中平均出血量为(72.38±34.24)mL.术后胃肠功能平均恢复时间为(2.77±0.65)d,术后平均住院时间为(7.04±2.24)d.术后腹腔内出血1例,吻合口狭窄1例,均经保守治疗后好转.术后病理(按照改良NIH标准),中危患者18例(69.23%),高危患者8例(30.77%).术后口服格列卫辅助治疗12例.术后肝脏多发转移1 例,其余患者未见局部复发及远处转移.结论:直径大于5 cm的胃GIST患者行腹腔镜切除的中短期疗效确切且安全可行.%Objective:To investigate the feasibility,moderate-and short-term efficacies of laparoscopic surgery in the resection of the gastric gastrointestinal stromal tumors(GIST)with the tumor diameter more than 5 cm.Methods:The clinicopathological data of 26 gastric GIST patients with the diameter more than 5 cm underwent laparoscopic complete resection were retrospectively analyzed.The postoperative recovery,complications and moderate-and short-term prognosis of the patients were observed.Results:All the patients underwent laparoscopic surgery resection without open operation.According to the location and growth types of tumors,the total gastrectomy was performed in 1 case,the approximal gastrectomy was performed in 2 cases,the distal gastrectomy was performed in 2 cases,and the gastric local resection was performed in the rest 20 cases.The mean diameter of tumors was (5.94±1.28) cm,the mean operational time was (84.23±27.02) min,and the mean blood loss was (72.38±34.24) mL.The postoperative recovery time of bowel function was (2.77±0.65)d and the mean length of postoperative hospitalization time was (7.04±2.24) d.There was 1 case of intraperitoneal hemorrhage and 1 case of anastomotic stenosis;they recovered after conservative therapy.The postoperative pathology results(according to the modified NIH standard) indicated the number of moderate-risk patients was 18(69.23%),and the number of high-risk patients was 8(30.77%).A total of 12 cases accepted the adjuvant therapy with imatinib.There was 1 case of hepatic multimetastasis,and there was no local recurrence or death in the other patients.Conclusion:The moderate-and short-term efficacies of laparoscopic surgery in the gastric GIST patients with the tumor diameter more than 5 cm is safe and feasible.