内镜联合腹腔镜切除胃肠道间质瘤可行性研究

目的研究内镜联合腹腔镜对胃肠道间质瘤进行切除的可行性及其临床疗效。方法选择2008年4月至2012年4月间诊治的102例胃肠道间质瘤患者，其中男性60例，女性42例；年龄在20~79岁，平均为（57．8±6．7）岁。62例为胃间质瘤，行腹腔镜联合胃镜治疗；40例为肠道间质瘤，运用腹腔镜联合肠镜进行治疗。所有患者围手术期均行胃肠减压、补充液体、营养支持以及预防性应用抗生素。待肠道功能恢复后，拔除胃管。短期内进行流质饮食，逐步过渡到正常饮食。对所有患者进行半年以上的随访观察。结果所有患者均成功实施手术，病变部位定位准确，手术过程所需时间为40-80min，术中出血量在5-30ml，无中转开腹手术的患者；术后无吻合口出血及吻合口漏等并发症。所有患者随访半年，均无肿瘤复发。结论两镜联合治疗胃肠道间质瘤，疗效明确，手术的安全性高，同时降低了开腹手术给患者带来的痛苦和损伤，是目前治疗胃肠道间质瘤的较为理想的一种方法。     

胃镜腹腔镜联合治疗胃间质瘤19例

目的：探讨胃镜、腹腔镜联合治疗胃间质瘤的可行性。方法：对19例胃间质瘤患者行腹腔镜辅助内镜联合手术治疗11例,内镜辅助腹腔镜联合手术治疗8例。观察两组并发症、手术时间、术后进食时间及住院时间等临床指标。结果：19例双镜联合胃间质瘤切除术均获成功,无中转开腹。结论：腹腔镜和胃镜联合治疗胃间质瘤充分发挥了各自优势,拓展了胃镜、腹腔镜的手术指证,保障了手术的安全性。     

双镜联合技术在胃间质瘤治疗中的应用体会

目的:总结双镜联合技术治疗胃间质瘤的临床价值及经验体会。方法:回顾分析为27例患者行双镜联合胃间质瘤手术的临床资料。结果:6例行腹腔镜辅助内镜手术,内镜下切除肿瘤,腹腔镜辅助暴露内镜术野、监视并处理内镜手术穿孔、出血等并发症。肿瘤均属腔内型,最大径平均(2.2±0.8)cm,术中出血量平均(20.5±15.5)ml,手术时间平均(90.5±30.0)min,肛门排气时间平均(20.5±12.6)h,术后平均住院(4.5±1.8)d,1例术中胃壁穿孔,腹腔镜下胃壁浆肌层缝合加固,无肿瘤残留、其他并发症发生。21例行内镜辅助腹腔镜手术,腹腔镜下切除肿瘤及部分胃壁,内镜辅助定位并检查吻合口或胃壁闭合口。肿瘤属腔外型12例、壁间型5例、腔内型4例,最大径平均(4.5±2.2)cm,术中出血量平均(60.8±25.4)ml,手术时间平均(102.3±32.4)min,肛门排气时间平均(24.8±15.2)h,术后平均住院(5.2±2.0)d,无肿瘤残留及并发症发生。内镜辅助腹腔镜手术组肿瘤大小、术中出血量显著高于腹腔镜辅助内镜手术组(P0.05),其余指标未见统计学差异。结论:双镜联合技术具有微创优势,其中内镜辅助腹腔镜手术在胃间质瘤治疗中应用更为广泛。     

双镜联合微创技术在胃间质瘤治疗中的临床效果评价

探讨双镜联合技术在胃间质瘤治疗中的临床应用价值。采用随机对照研究,各组患者均择期手术治疗,入院后随机分为内镜治疗组、双镜联合组及腹腔镜手术组,观察比较各组在手术效果及并发症方面的差异性。三组在手术时间、术中出血量、术后首次排气时间方面差异有统计学意义(P0.05),其中双镜联合组手术时间和术中出血量明显低于其余各组,住院时间、并发症发生率等方面差异均无统计学意义(P0.05),但双镜联合组无术后吻合口瘘、出血及狭窄等并发症发生。内镜治疗、双镜联合及腹腔镜手术治疗胃间质瘤的住院时间、手术并发症等结果相似,但双镜联合切除术可有效缩短手术时间,减少术中出血量,并且不易出现手术意外。     

腹腔镜联合胃镜与开腹手术治疗胃间质瘤临床比较研究

目的比较腹腔镜联合胃镜和同期开腹手术治疗胃间质瘤病例的治疗效果。方法回顾性分析2010年1月至2015年3月期间笔者所在医院施行腹腔镜联合胃镜治疗胃间质瘤的56例患者的临床资料,并与同期53例行开腹胃间质瘤手术病例进行对比分析;观察2组患者的一般资料、手术相关指标、手术并发症资料及随访结果。结果 2组患者的一般资料、术中情况、手术后总的并发症率、局部复发及远处转移比较差异均无统计学意义(P0.05)。腹腔镜联合胃镜组术中发生肿瘤破裂1例,中转开腹1例;开腹组无肿瘤破裂者。2组无围手术期死亡病例,均未发生明显胃出血、吻合口狭窄、吻合口漏等并发症。与开腹组相比,腹腔镜联合胃镜组术中失血量及术后腹腔引流量明显减少,术后肛门排气时间、术后止痛剂使用时间及术后住院时间明显缩短,但住院总费用较高,手术时间较长,其差异有统计学意义(P0.05)。结论在严格掌握适应证和丰富的开腹胃间质瘤手术经验和熟练的腹腔镜手术技术的基础上,腹腔镜联合胃镜治疗胃间质瘤,能取得与开腹手术同样的疗效,并具有出血少、恢复快等优势。     

腹腔镜手术治疗胃间质瘤的疗效分析

目的:探讨腹腔镜手术治疗胃间质瘤的可行性及临床应用价值。方法:回顾分析2011年6月至2014年9月腹腔镜治疗胃间质瘤43例患者的临床资料。结果:1例发生肿瘤破裂、1例切口感染。无中转开腹及围手术期死亡病例,均未发生明显胃出血、吻合口狭窄、胃瘫及吻合口漏等严重并发症。其中腹腔镜胃楔形切除术21例,腹腔镜经胃肿瘤外翻切除术15例,腹腔镜辅助远端胃大部切除术4例,腹腔镜辅助近端胃大部切除术3例。手术时间50~192 min,平均(85.3±53.6)min;术中出血量20~150 ml,平均(80.6±42.3)ml;术后住院7~15 d,平均(9.1±4.7)d。肿瘤直径2.0~6.3 cm,平均(3.6±2.9)cm,切缘均阴性。免疫组化染色提示:CD117阳性41例,CD34阳性36例,DOG-1阳性42例。Fletcher风险分级:极低复发危险25例,低度复发危险13例,中度复发危险4例,高度复发危险1例。术后随访10~49个月,1例复发,余者均无肿瘤局部复发、远处转移。结论:在严格掌握适应证、丰富的开腹手术经验及熟练的腹腔镜手术技术基础上,腹腔镜手术治疗胃间质瘤是安全、可行的。     

腹腔镜胃间质瘤切除术的疗效

目的 探讨用腹腔镜手术治疗胃间质瘤的可行性.方法 回顾性分析我院2003年6月至2007年10月腹腔镜手术治疗20例胃间质瘤患者的临床资料,其中13例位于胃前壁,7例位于胃后壁.结果 本组20例患者手术均获得成功,无中转开腹,无术后严重并发症发生.手术时间(60±34)min,术中出血15～120ml,患者住院时间(6.0±2.6)d.随访10～22个月,无复发及转移.结论 采用腹腔镜手术治疗胃间质瘤技术安全可行,并能明显减轻患者的手术创伤.     

经脐单孔腹腔镜手术治疗胃良性疾病的探讨

目的探讨利用传统腹腔镜器械行经脐单孔腹腔镜手术治疗胃良性疾病的临床应用前景。方法 2009年5月至2011年5月,12例胃间质瘤及4例良性消化性溃疡患者完成经脐单孔腹腔镜胃部分切除术、胃大部切除术,总结手术方法及临床疗效。结果 12例胃间质瘤患者顺利完成经脐单孔腹腔镜胃部分切除术,手术平均用时110min,术中平均出血量90ml,术后平均住院时间5d。4例良性消化性溃疡合并幽门梗阻患者中,1例因术中局部粘连重中转开腹,其余3例手术顺利,平均手术时间290min,术中平均出血量220ml,术后平均住院时间7d。全组病例无术后出血、吻合口漏及吻合口梗阻等并发症发生,患者恢复好。结论经脐单孔腹腔镜手术治疗胃良性疾病安全、可行,并可以达到良好的美容效果。     

腹腔镜、结肠镜联合治疗结直肠良恶性肿瘤的应用体会(附21例报告)

目的:探讨腹腔镜、纤维结肠镜联合治疗结直肠良恶性肿瘤的应用价值.方法:回顾分析为21例结直肠良恶性肿瘤患者应用多种双镜联合治疗方法的临床资料.结果:手术均顺利完成,无一例中转开腹.其中内镜辅助腹腔镜治疗12例,腹腔镜辅助内镜治疗4例,内镜腹腔镜同步切除2例,腹腔镜追加根治术3例.术后无吻合口漏、吻合口出血等并发症发生....     

双镜联合技术在胃间质瘤切除术中的应用

目的探讨腹腔镜与胃镜双镜联合手术治疗胃间质瘤的可行性和安全性。方法对2003年12月至2009年12月间采用腹腔镜与胃镜双镜联合行胃间质瘤切除手术的23例患者的临床资料进行回顾性分析,其中18例行经胃镜定位腹腔镜胃腔外胃部分切除术、1例行经胃镜定位腹腔镜胃腔内胃部分切除术、4例行胃镜下肿瘤切除联合腹腔镜胃壁修补缝合术。结果 23例手术均获成功,无中转开腹,无手术死亡和并发症。手术时间30～95min,平均(66.5±20.1)min,术中出血量1~20ml,平均(12.0±17.1)m1,术后平均住院日(4.9±1.8)d。术后病理结果示:极低度风险15例、低度风险8例。随访3～75个月,无肿瘤复发和远处转移。结论腹腔镜和胃镜双镜联合手术治疗胃间质瘤是安全可行的,近期疗效令人满意,远期结果有待进一步观察。     

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??Cardiac endogenous gastric intestinal stromal tumors with laparoscopic intragastric surgery??An analysis of 9 cases WANG Jun-jiang*?? YANG Zi-feng??FENG Xing-yu, et al. *Department of General Surgery, Guangdong General Hospital, Guangzhou 510080, China
Corresponding author: LI Yong, E-mail: yuan821007@126.com
Abstract Objective To evaluate the quality and clinical efficacy of laparoscopic intragastric surgery for the cardiac endogenous gastric intestinal stromal tumors, analyze its safety, feasibility and clinical value. Methods The clinical data of 9 cases of cardiac endogenous stromal tumors performed laparoscopic intragastric surgery from June 2014 to March 2016 in Guangdong General Hospital were analyzed retrospectively. Results Nine cases were operated by laparoscopy successfully without conversion to open surgery. The operative time ranged 59 to 104 minutes and blood loss was from 5 to 65 mL. Nine cases were dianosed with gastric intestinal stromal tumors pathologically and recovery time was from 1 to 4 days, eating time 2 to 4 days, drainage time 3 to 4 days, discharge time 4 to 6 days. There was no postoperative bleeding, anastomotic leakage, cartiac stenosis and other complications. All followed-up patients had no swallowing disorders and acid reflux symptoms and no signs of recurrence and metastasis at present. Conclusion The laparoscopic intragastric treatment for cardiac endogenous gastric intestinal stromal tumors is safe and feasible. But it needs high laparoscopic surgical technique . So carrying out needs to be cautiously.     

腹腔镜辅助经胃腔治疗贲门部内生型胃肠间质瘤9例临床分析

目的 分析腹腔镜辅助经胃腔治疗贲门部内生型胃肠间质瘤的临床疗效,探讨其安全性、可行性及临床应用价值。方法 回顾性分析2014年6月至2016年3月广东省人民医院9例行腹腔镜辅助经胃腔治疗贲门部内生型胃肠间质瘤病人的临床资料。结果 9例病人均顺利完成手术,无中转开腹,手术时间59～104 min,术中出血量5～65 mL。经术后病理学检查均确诊为胃肠间质瘤。术后胃肠道恢复时间1～4 d,进食时间2～4 d,引流管留置时间3～4 d,出院时间为术后4～6 d;无术后出血、吻合口瘘、贲门狭窄等并发症。所有病人术后均未出现吞咽障碍及反酸症状,随访均未出现复发及转移迹象。结论 腹腔镜辅助经胃腔治疗贲门部内生型胃肠间质瘤安全、可行,但该术式对腹腔镜操作技术要求高,需谨慎开展。     

腹腔镜联合胃镜治疗邻近贲门或幽门的胃间质瘤

目的探讨腹腔镜联合胃镜行胃楔形切除治疗邻近贲门或幽门的胃间质瘤的安全性和可行性。方法2006年9月～2008年11月对5例特殊部位的胃间质瘤（3例肿瘤距离贲门≤5cm,2例距离幽门≤5cm）采用腹腔镜联合胃镜进行胃楔形切除。切割闭合器切除肿瘤过程中,胃镜于胃腔内实时观察和调整切割缘位置,避免损伤贲门或者幽门,确保肿瘤完整切除且胃腔无狭窄。结果5例均成功完成腹腔镜联合胃镜胃楔形切除,肿瘤完整切除,无肿瘤破裂,无胃腔狭窄,无中转开腹。手术时间60～110min,平均84min;术中出血量10～50ml,平均30ml。术后中位排气时间3d,中位进流食时间术后3d。术后病理切缘均为阴性。1例术后出现粘连性肠梗阻（经保守治疗后缓解）,其余4例未出现手术相关并发症。术后3个月行胃镜以及钡餐造影,无胃腔狭窄。5例平均随访27.8月（8～34个月）,未发现肿瘤复发和转移。结论对于邻近贲门或幽门的胃间质瘤,腹腔镜联合胃镜行胃楔形切除是安全和可行的,符合胃肠道间质瘤的治疗原则,可以避免胃腔狭窄。     

腹腔镜胃局部切除术的临床应用

目的 评价腹腔镜胃局部切除术的临床应用价值.方法 回顾性分析2006年2月至2010年1月解放军总医院收治的78例行腹腔镜胃局部切除术患者的临床资料.根据病灶的位置和游离范围,采用全腹腔镜下胃局部楔形切除术、腹腔镜辅助下胃局部切除术和腹腔镜联合内镜切割吻合器肿瘤切除术.探讨患者的手术疗效.结果 78例患者均在腹腔镜下成功完成胃局部切除手术,无一例中转开腹.其中,45例行全腹腔镜胃局部楔形切除术,22例采用腹腔镜辅助下胃局部切除术,11采用腹腔镜联合内镜切割吻合器肿瘤切除术.平均手术时间为75 min(45～120 min),术中平均出血量为60 ml(35～90 ml),切除病灶平均直径为(2.5±1.3)cm(0.7～4.8 cm).术后患者无并发症发生及死亡.术后肠道功能平均恢复时间为35 h(25～42 h),术后平均住院时间为7.5 d(6～9 d).术后病理检查:63例患者为胃间质瘤;11例患者为胃良性疾病,其中异位胰腺组织5例、炎性假瘤2例、增生性息肉2例、神经鞘瘤1例、血管瘤1例;4例患者为类癌,其中位于黏膜层3例、累及深肌层1例.本组患者中位随访时间为26个月,未发现术后出血、吻合口狭窄及戳孔种植.63例胃间质瘤患者中,2例术后行甲磺酸伊马替尼治疗、1例肿瘤复发行再次手术治疗,术后恢复良好.结论 腹腔镜胃局部切除术治疗胃良性疾病、胃间质瘤及早期胃癌安全、可行.

Abstract：

Objective To evaluate laparoscopic local resection for the treatment of gastric tumors. Methods The clinical data of 78 patients who received laparoscopic local resection at the PLA General Hospital from February 2006 to January 2010 were retrospectively analyzed. According to the tumor site and free range, total laparoscopic gastrectomy was applied to 45 patients, laparoscopic local resection was applied to 22 patients, laparoscopic and endoscopic tumor resection was applied to 11 patients. The efficacies of the surgical approaches were investigated. Results Laparoscopic local resection was successfully performed on the 78 patients without conversion to open surgery. The mean operation time and operative blood loss were 75 minutes (range, 45-120 minutes) and 60 ml (range, 35-90 ml), respectively. The mean diameter of the tumor was (2.5±1.3)cm (range, 0.7-4.8 cm). No mortality or morbidity occurred postoperatively. The bowel function recovery time and the duration of hospital stay were 35 hours (range, 25-42 hours) and 7.5 days (range, 6-9 days), respectively. The results of postoperative pathological examination verified that 63 patients were with gastric stromal tumor, 11 patients were with benign gastric diseases, including 5 with gastric heterotopic pancreas, 2 with inflammatory pseudotumor, 2 with hyperplastic polyp, 1 with schwannomas and one with angioma. Four patients were with carcinoid, 3 carcinoids were located in mucous layer and 1 invaded into muscular layer. The median time of follow-up was 26 months, and no anastomotic stenosis or port-site metastasis was observed. Of the 63 patients with gastric stromal tumor, 2 were treated with imatinib mesylate, 1 had tumor recurrence and received reoperation. Conclusion Laparoscopic local resection is safe and feasible for the treatment of benign gastric neoplasms, stromal tumor and early gastric tumors.     

内镜难治性胃肠道出血介入诊疗的安全性和有效性

目的评价内镜难治性胃肠道出血介入诊疗的安全性和有效性。方法对31例内镜难治性胃肠道出血患者行DSA检查,明确出血部位后行出血动脉栓塞治疗,并评价其安全性和疗效。结果血管造影发现出血阳性率为80.65%(25/31),28例行栓塞止血治疗,1次栓塞止血成功率75.00%(21/28),2次栓塞总成功率82.14%(23/28)。7例介入术后行外科手术,包括2例空肠间质瘤及5例胃恶性肿瘤。4例胃恶性肿瘤患者介入术后30日内再发间断出血,其中2例因基础疾病致心肺衰竭死亡。除1例胃肠吻合术后吻合口出血患者栓塞止血术后出现吻合口瘘,经支持治疗后恢复出院,余患者未出现严重胃肠缺血坏死。结论介入诊疗对胃肠道出血的诊断及止血治疗高效、安全,尤其对胃恶性肿瘤出血亦能取得良好效果,可作为内镜难治性胃肠道出血的一种较好的诊治手段。     

腹腔镜微创外科治疗胃肠间质瘤43例分析

目的 评价胃肠间质瘤的临床诊断及行腹腔镜手术治疗的可行性与安全性.方法 回顾性分析2006年8月-2009年6月43例超声内镜拟诊胃肠道间质瘤的临床诊断与治疗资料.结果 腹腔镜手术成功36例,成功率为83.7%.超声内镜诊断率为69.O%.术后诊断胃肠道间质瘤免疫组化CD117、CD34标记阳性率为100%.术后患者平均住院时间为5 d,术后疼痛轻微.结论 超声内镜及CD117、CD34标记可以作为胃肠道间质瘤临床影像学诊断及免疫学诊断的重要手段,腹腔镜手术切除胃肠间质瘤是安全可行的.     

Laparoscopic wedge resection of a gastric leiomyoma

Gastric stromal tumors represent a small percentage of gastric neoplasms. Establishing a diagnosis when these lesions are encountered usually is not possible with limited biopsies. Benign and malignant gastric stromal tumors require only local excision for definitive treatment. However, most lesions are not amenable to endoscopic excision. As a result, laparoscopic local excision offers the ideal method to establish a diagnosis and to treat patients with gastric smooth muscle tumors. We present a minimally invasive local excision of a gastric stromal tumor. We also review the previously published management of gastric stromal tumors and show how it is being influenced by laparoscopy.     

Surgical Management of Small Gastrointestinal Stromal Tumors of the Stomach

Small gastrointestinal stromal tumors (GISTs) (<3 cm) occasionally are found in the stomach during endoscopy. There is no consensus about the surgical management of these small tumors, although this clinical issue is crucial because some of the tumors show unexpected malignant behavior. In this study, we evaluated the clinical management of patients with gastric GISTs who underwent surgical resection. Altogether, 31 patients with gastric GISTs were examined retrospectively. Surgical resection was fundamentally indicated for the patients with gastric GISTs suspected to be malignant by endoscopy or endoscopic ultrasonography (EUS). The malignant grade of the GISTs was evaluated by the mitotic rate, tumor size, and MIB-1 index. EUS was useful for differentiating benign from malignant GISTs; but by limiting the study to patients with small tumors (<3 cm), the diagnostic value of EUS was not satisfactory for defining the surgical indication. Tumors that were <50 mm were successfully treated by laparoscopic surgery. Of the 31 patients, 4 had a relapse of the disease, and 1 of those 4 patients had a small tumor (30 mm). All of the recurrences were classified in the high risk category. Surgery is indicated for gastric GISTs that are ≥20 mm or are suspected to be malignant based on EUS findings. Laparoscopic resection is feasible and is recommended as the treatment of choice for patients with tumors < 50 mm. Risk assessment can be most useful for predicting recurrence.     

Endoscopic band ligation of small gastric stromal tumors and follow-up by endoscopic ultrasonography

Background Gastrointestinal stromal tumor (GIST) is a relatively common gastric submucosal tumor with potential for malignant transformation. The efficacy of a new method for resection of these tumors, endoscopic band ligation, was evaluated. Methods The study included 29 patients with small gastric stromal tumors arising in the gastric muscularis propria as determined by endoscopy, endoscopic ultrasonography (EUS), and deep endoscopic biopsies. A standard endoscope with a transparent cap attached to the tip was used. The cap was placed over the lesion, maximum sustained suction was applied, and an elastic band was released around the base. Beginning two weeks after banding, the lesions were observed endoscopically once per week until healing was complete. Thereafter, all patients underwent EUS every two to three months on schedule. Results The 28 GISTs sloughed completely. The mean time required for complete healing after band ligation was 4.8 weeks. One lesion did not slough because they were not completely ligated. The lesion was ligated for the second time and sloughed completely. Bleeding occurred in one patient three days after ligation because the lesion sloughed early. The bleeding was managed successfully with metallic clips. No perforation and other complications occurred. Followup ranged from 36 to 51 months, during which time only one recurrence was observed four months postoperatively. Conclusions Endoscopic band ligation with systematic followup by EUS is an effective and safe treatment for small GISTs.