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。

Laparoscopic and Endoscopic Cooperative Dissection for Gastric Stromal Tumors Near to the Cardia or Pylorus

Objective To evaluate the safety and feasibility of laparoscopie and endoscopic cooperative dissection for gastric stromal tumors located near to the cardia or pylorus. Methods From September 2006 to November 2008, we performed laparoscopic gastric wedge dissection monitored by endoscopy on 5 cases of gastric stromal tumors, which located near to （ ≤5 era） the cardia or pylorus. The clinical and pathological data of the patients were retrospectively analyzed. Results In these 5 cases, 3 had the tumors located ≤5 cm to the eardia and 2 had tumors located ≤5 cm to the pylorus. The operation was successfully completed in all of the cases without rupture of the tumor, stenosis of the gastric cavity or conversion to open surgery. The mean operation time was 84 min in this series （range, 60 to 100 min）. The intraoperative blood loss ranged from 10 to 50 ml with a mean of 30 ml. In a median of 3 days, the patients had the first postoperative flatus and began to take fluid food. After the operation, pathological examination showed negative margin in all of the 5 cases. One patient developed adhesive intestinal obstruction, and were cured by conservative therapy. No other postoperative complications were ound. Three months a（ter the operation, all the patients received re-examination by angiography of the gastrointestinal tract and gastroscopy, which showed no stenosis of the gastric cavity. The 5 cases were followed up for 8 to 34 months （ mean, 27.8 months） , none of them had recurrence or metastasis of the tumor. Conclusions Laparoseopic and endoscopic cooperative gastric wedge dissection is safe and feasible for gastric stromal tumors located near to the cardia or pylorus. This procedure fits to the therapeutic criteria of gastric stromal tumors, and can effectively avoid the stenosis of the gastric cavity.