Gastric stromal tumor

Gastric stromal tumors display a bewildering array of immunohistological and ultrastructural features as well as variable biological behavior. These tumors are rare as compared with ones that arise from the gastric epithelium. Moreover, they have been the subjects of controversy because of their uncertain histogenesis. We report the pathological features of gastric stromal tumors we recently encountered in three patients.     

腹腔镜手术治疗胃胃肠间质瘤疗效分析

【摘要】 目的 探讨腹腔镜手术治疗胃胃肠间质瘤(GIST)的可行性。方法〓回顾性分析2009年1月至2014年1月间,在我院接受腹腔镜手术治疗的27例胃胃肠间质瘤患者的临床资料,并统计具体手术方式,手术时间,术中出血量,手术切口长度,肿瘤大小及住院时间。结果〓根据胃肿瘤大小和部位选择不同手术方式,其中胃局部切除术病人20例,远端胃大部切除术5例,全胃切除术2例。其中胃局部切除术20人均在完全腹腔镜下完成,其余7例病人行腹腔镜辅助切除手术。手术时间81.3±16.2 min,术中出血量42.1±9.2 mL,手术切口长度5.6±2.4 cm,肿瘤直径4.8±1.3 cm,住院时间7.5±2.6 d。结论〓腹腔镜手术治疗胃胃肠间质瘤安全可行、恢复快。     

Gastrointestinal stromal tumor of the stomach successfully treated by laparoscopic proximal gastrectomy with jejunal interposition

The authors describe a patient with a bleeding gastrointestinal stromal tumor of the stomach who was treated successfully by laparoscopic proximal gastrectomy with jejunal interposition. Immunohistochemically, the tumor was positive for vimentin and CD34 and was diagnosed as a gastrointestinal stromal tumor of low-grade malignancy. Because it is difficult to diagnose this disease preoperatively and a malignant phenotype has been reported, resulting in liver metastasis and peritoneal dissemination, it is desirable to treat this disease with as little manipulation as possible. To achieve this, laparoscopic surgery is a feasible option for the treatment of gastrointestinal stromal tumors.     

胃间质瘤腹腔镜切除与开放手术疗效对比研究

目的：比较胃间质瘤（GST）腹腔镜切除和开放手术方法的效果及预后。方法回顾性分析2008年6月至2013年3月收治的胃间质瘤患者63例,其中37例采用腹腔镜切除（腹腔镜组）,26例为传统开放手术切除（开放组）,分析对比两组患者临床病理特征、手术情况及随访资料等。结果（1）腹腔镜组手术时间为（60.7±16.6）min,明显短于开放组的（127.7±31.3）min （t=11.023）;腹腔镜组的胃管拔出时间短于开放组[（2.6±0.7）d vs（5.6±1.1）d,t=13.231],术中出血量更少[（56.8±10.0）ml vs（104.4±21.2）ml,t=11.927],住院时间更短[（5.8±0.8）d vs（10.9±1.4）d, t=18.339],差异均有统计学意义（P〈0.01）。（2）腹腔镜组患者中位生存期为56.3个月,开放组中位生存期为48.6个月。Log-Rank检验显示组间差异有统计学意义（P〈0.05）;腹腔镜组患者无复发,开放组无复发生存率85.0%,组间差异有统计学意义（P=0.039）。结论相对于开放手术,腹腔镜胃间质瘤切除具有手术时间短、住院时间短、复发率低等优势。     

Gastric stromal tumor. Case report

Gastrointestinal stromal tumors (GIST) are the most common mesenchymal tumors of the gastro intestinal tract and express the c-kit proto-oncogene protein (CD-117). We report herein a case of a 58 years old male with upper abdominal pain and anaemia. Preoperative endoscopic and barium meal exams showed a submucosal tumor in the gastric fornix. Endoscopic biopsy revealed spindle-shaped cells with elongated nuclei specific of GIST. We performed a stapled resection of the gastric fornix associated with Hiss angle reconstruction. Postoperative histologic exam revealed the same spindle-shape cells characteristic of GIST with 2-5 mitosis/50HPF. Almost all of the cells showed immunoreactivity for c-kit, CD-34 and a Ki-67 labeling index of 30%. Postoperative course was non eventful and after 3 month the patient has no recurrence. CONCLUSIONS: GIST are rare gastric tumors and are usually associated with bleeding and abdominal pain. The preoperative diagnosis is usually established by endoscopy with biopsy or endoscopic ultrasonography fine needle aspiration and barium meal exam. Only immunoreactivity is able to differentiate GIST from other mesenchymal tumors. Surgical resection is a safe and effective treatment. The chemotherapy with tyrosine kinases competitive inhibitors (e.g. imatinib mesylate) is also recommended.     

Sporadic gastric carcinoid tumor successfully treated by two-stage laparoscopic surgery: A case report

We report a case of sporadic gastric carcinoid tumor successfully treated by two-stage laparoscopic surgery. A 38-year old asymptomatic woman was referred to our hospital for evaluation of a submucosal tumor of the stomach. Endoscopic examination showed a solitary submucosal tumor without ulceration or central depression on the posterior wall of the antrum and biopsy specimens were not sufficient to determine the diagnosis. Endoscopic ultrasound revealed a tumor nearly 2 cm in diameter arising from the muscle layer and a computed tomography scan showed the tumor enhanced in the arterial phase. Laparoscopic wedge resection was performed for definitive diagnosis. Pathologically, the tumor was shown to be gastric carcinoid infiltrating the muscle layer which indicated the probability of lymph node metastasis. Serum gastrin levels were normal. As a radical treatment, laparoscopy-assisted distal gastrectomy with regional lymphadenectomy was performed 3 wk after the initial surgery. Finally, pathological examination revealed no lymph node metastasis.     

双镜联合技术在胃间质瘤治疗中的应用

胃肠道间质瘤(GIST)是胃肠道最常见的间叶源性肿瘤.对于未发生转移的GIST,手术切除是首选的治疗措施.近年来随着腹腔镜外科、内镜外科等微创外科技术的不断发展和成熟,双镜联合技术(LECS)已逐渐发展为胃间质瘤治疗中一种较为成熟的微创手术方式.本文将就近年来双镜联合技术在胃间质瘤治疗中的应用做一综述.     

腹腔镜与开腹手术治疗胃肠间质瘤的疗效对比

目的探讨腹腔镜与开腹手术对胃肠间质瘤（GIST）手术切除的疗效。 方法选择2011年5月至2014年5月收治的胃肠间质瘤患者90例,按照随机数字表法分为腹腔镜组45例和对照组45例,对照组采用传统开腹手术,腹腔镜组行腹腔镜下肿瘤切除术。比较两组患者手术一般情况、术后并发症。术后随访6个月,采用流式细胞仪检测两组患者术前及术后各时段T淋巴细胞CD₃₊、CD₄₊、CD₈₊、CD₄₊/CD₈₊变化水平。 结果与对照组比较,腹腔镜组术中出血量、术后排气时间、术后活动恢复时间、进食时间、住院时间均显著缩短（P<0.05）;两组患者术后主要并发症有胃瘫、伤口脂肪液化、切口感染、肠梗阻、伤口不愈合等,其中腹腔镜组肠梗阻、伤口不愈合发生率显著低于对照组（P<0.05）,两组患者术后复发、转移发生率比较差异无统计学意义。两组患者术后1个月时CD₃₊、CD₄₊、CD₄₊/CD₈₊均逐渐降低,CD₈₊逐渐上升,此后CD₃₊、CD₄₊、CD₄₊/CD₈₊逐渐升高,CD₈₊逐渐降低;其中术后各时段腹腔镜组CD₃₊、CD₄₊、CD₄₊/CD₈₊显著高于同时段对照组,CD₈+显著低于同时段对照组（P<0.05）。 结论腹腔镜手术治疗GIST近期疗效优于传统开腹手术,且对患者免疫功能影响更小,有利于患者预后。     

Gastroduodenal intussusception due to gastrointestinal stromal tumor (GIST) treated by laparoscopic billroth II distal gastrectomy

Gastrointestinal stromal tumors are rare tumors of the gastrointestinal tract. They, however, occur most commonly in the stomach where they present with abdominal pain, bleeding, and obstruction. Many are asymptomatic and are discovered incidentally or at postmortem. We present a case-report of a rare complication of gastrointestinal stromal tumors of the stomach causing gastroduodenal intussusception and how patient was successfully managed by laparoscopic Billroth II distal gastrectomy.     

Serous cysts of the spleen treated by laparoscopic surgery

The authors present two case of a 25 years and 32 years old male patients with serous cysts of spleen that were detected on an random abdominal ultrasonography. Abdominal pain in the left hypocondrium was only symptom of this patients. The patients was operated by laparoscopic method, with Ultra-Shears and intraoperative ultrasonography examination. This kind of techniques give us the opportunity to performed the ablation of the cysts with preservation of the spleen with fast full recovery.     

Small intestine gastric balloon impaction treated by laparoscopic surgery

Background: The BioEnterics? intragastric balloon device (BIB) is being used as an adjunct for treatment of obesity.This procedure may have complications, mainly related to the migration of the balloon in the bowel, with abdominal cramping before anal extrusion. Methods: We report a case of migration of a deflated BIB in the small bowel with obstruction. This device had been implanted 7 months earlier. Results: The plain radiograph and the CT scan confirmed the diagnosis, and the patient was operated with opening of the bowel for removal of the device and the impacted food. The whole procedure was done via laparoscopy.The patient left the hospital on the 7th postoperative day. Conclusion: We report a small bowel obstruction by migration of a deflated BIB.     

3D腹腔镜手术治疗胃底部间质瘤的临床疗效

目的:探讨3D腹腔镜手术治疗胃底部间质瘤的临床应用价值。方法:回顾性分析武汉大学人民医院2014年1月—2015年6月间收治的36例胃底部间质瘤患者临床资料,其中18例行3D腹腔镜手术(3D腔镜组),18例行开腹手术(开放手术组),比较两组患者的围手术期指标,术后病理资料及复发转移情况。结果:两组患者在年龄、性别、BMI、肿瘤大小等一般资料方面差异无统计学意义(均P0.05)。两组手术时间差异无统计学意义(P0.05),但3D腔镜组在术中出血量、手术切口长度、术后排气时间及住院天数等指标方面均明显优于开放手术组(均P0.05)。两组患者均未出现肿瘤破裂以及切缘阳性的情况,均未发生大出血、吻合口瘘、术后肠梗阻等严重并发症,术后病理及免疫组化特征均无明显差异(均P0.05)。所有患者随访12~36个月,无复发、转移及死亡病例。结论:应用3D腹腔镜技术治疗胃底部间质瘤,能明显减少患者的手术创伤,且远期疗效与开放手术相似。     

Gastric cancer mimicking a submucosal tumor diagnosed by laparoscopic excision biopsy

We report a case of advanced gastric cancer exhibiting the features of a submucosal tumor (SMT) of the gastric body. The patient was a 50-year-old male in whom a gastric SMT was detected during a mass screening examination. Upper gastrointestinal endoscopy revealed a protuberant tumor, 2 cm in diameter, covered with normal-appearing mucosa. Examination of an endoscopic biopsy specimen of the tumor revealed chronic gastritis with regenerative and erosive changes. An endoscopic ultrasound examination demonstrated a hypoechoic mass in the third layer of the gastric wall. The clinical diagnosis was gastric SMT, and the patient's course was monitored. Twenty-six months after the initial visit to our hospital, an endosonograph-guided biopsy revealed Group III (borderline lesion). Three months after the biopsy, the size of the SMT had increased slightly. Laparoscopic wedge resection of the tumor was performed to make a pathologic diagnosis and we were able to make a diagnosis of gastric lymphoepithelioma-like carcinoma intraoperatively. Gastrectomy with lymph node dissection was followed as curative surgery. Laparoscopic total excision biopsy is a useful technique in patients with a gastric SMT whose diagnosis has not been confirmed pathologically.     

腹腔镜与胃镜联合治疗胃间质瘤

The combination of laparoscopy and gastroscopy makes up the defects of each of them when used alone, and further extends the application range of minimally invasive techniques. A 53-year-old patient with gastric stromal tumor was admitted to the Tenth People's Hospital of Tongji University on March 4, 2011. The result of gastroscopy showed that the tumor was at anterior wall of stomach with a size of 3.0 cm×3.5 cm. the result of CT scan preliminarily diagnosed the patient with gastric stromal tumor. Partial gastrectomy with laparoscopy combined with gastroscopy was applied to the patient on March 9, 2011. The operation time was 32 minutes and the blood loss was 10 ml. The duration of hospital stay was 4 days, and no postoperative complication occurred. Laparoscopy combined with gastroscopy for the treatment of gastric stromal tumor is feasible and safe with a favorable short-term outcome.     

Pancreatic stromal tumor of nerve sheath origin treated by pancreatoduodenectomy.

A pancreatic sarcoma of nerve sheath origin is reported in a 28-year-old female patient, who presented with melaena. Preoperative imaging showed an 8.5 cm diameter mass in the head of pancreas. There was bleeding from the papilla of Vater at endoscopy and a highly vascular lesion on arteriography. The patient was submitted to proximal pancreatoduodenectomy and remains symptom-free at 1 year follow-up.     

Benign peritoneal multicystic mesothelioma diagnosed and treated by laparoscopic surgery

Benign cystic mesothelioma is a rare pathology predominantly encountered in females. The increased use of laparoscopy for abdominal pain, particularly in female patients, implies that surgeons are aware of the macro- and laparoscopic presentation of this tumor for adequate diagnosis and therapy. In this paper, we present the case of a young woman with benign multicystic mesothelioma in which only laparoscopy led to the appropriate diagnosis. Subsequently, the tumor was removed by laparoscopic surgery.     

胃镜辅助腹腔镜手术治疗胃间质瘤32例

目的 探讨胃镜辅助下腹腔镜手术在胃间质瘤治疗中的价值.方法 2008年6月至2011年6月共32例胃间质瘤患者接受胃镜辅助下腹腔镜手术治疗,对其手术时间、术中出血量、住院时间等资料进行综合分析.结果 32例手术均顺利完成,手术时间（65.3±23.4） min,术中出血量（54.5±15.7）ml,术后胃肠道功能恢复时间（47.90±13.53）h,术后住院时间（7.3±3.5）d,所有病例随访12 ～48个月,未见复发或远处转移.结论 胃镜辅助下腹腔镜手术治疗胃间质瘤安全、可行,手术创伤小,术后恢复快,是胃间质瘤手术治疗的理想方式.     

腹腔镜微创术治疗5～8 cm胃肠间质瘤的疗效及可行性分析

目的腹腔镜微创治疗5～8 cm胃肠间质瘤(GIST)的经验总结。方法回顾性分析我院行腹腔镜手术治疗(观察组)及开腹-手术治疗(对照组)的直径为5～8 cm GIST患者各48例临床资料。比较两组手术指标(包括手术时间、术中出血量、切口长度)和术后恢复情况(包括术后排气时间、术后进食时间、术后住院时间)差异,同时比较两组术后3个月内并发症发生情况,术后1年复发、转移、死亡情况及体力状况(东部肿瘤协作组织评分,ECOG)差异。结果观察组手术时间、术中出血量、切口长度、术后排气时间、术后进食时间、术后住院时间均明显低于对照组,差异均有统计学意义(P0.05)。术后3个月内,两组并发症发生情况比较无显著性差异(P0.05)。术后1年时,两组术后复发、转移及死亡情况及体力状况(ECOG评分)比较无显著性差异(P0.05)。结论腹腔镜手术与开腹手术在直径5～8 cm GIST治疗中均有明显的近期疗效及安全性,而腹腔镜手术具有良好的微创优势,于促进患者术后恢复更有利。