双镜联合手术治疗胃间质瘤39例

目的：探讨腹腔镜联合胃镜（双镜联合）手术治疗胃间质瘤的临床方法及效果。方法：胃间质瘤患者39例,瘤体直径1.0～4.5cm,平均（2.5±0.5）cm,均采用双镜联合方法手术切除。手术过程：胃镜下确定胃间质瘤的位置、大小,评估切除可能性及方法,腹腔镜下切除肿瘤,闭合切口,取出肿瘤,完成手术。术后接受免疫组织化学检查和肿瘤生物学风险评估,随访复发或转移情况。结果：1例因瘤体过大予以中转开放手术。余38例手术时间35～125min,平均（75±25）min。术中出血10～50mL,平均（25±10）mL;胃管留置时间0～24h,肠道功能恢复时间12～36h,绝对卧床12～24h,术后72～96h恢复流质饮食,术后平均住院5～7d。免疫组织化学结果：CD117阳性36例（92.3%）、CD34阳性32例（82.0%）;肿瘤生物学风险分级：极低危27例,低危10例,中危2例,高危0例。随访1～42个月,未发现种植或转移。结论：双镜联合手术治疗胃间质瘤具有快速定位、优化手术流程、术时短、创伤小、恢复快、安全有效等优点,适合于直径〈5cm、术中仅靠腹腔镜难以定位的瘤灶。手术对瘤体定位、手术组成员配合要求较高,需要富有经验的医师操作。

Laparoscopic and gastroscopic cooperative sugery for gastric stromal tumor in 39 patients

Objective：To investigate the clinical means and value of laparoscopy combined with gastroscopy resection of gastric stromal tumor.Metholds：Thirty-nine patients were treated with laparoscopic and gastroscopic surgeries.The diameter of tumors ranged 1.0～4.5 cm,with an average of（2.5±0.5）cm.Surgeries were performed according to the procedure：exposing and confirming the size and location of the tumor with gastroscopy;evaluating the possibility and practical method of resection;resecting the tumor with laparoscopy;suturing the incision;taking out the tumortissue and finishing the operation.The specimens were accepted imunohistochemistry（IHC）and risk assessment in oncobiology （RAO）.Results：one case was turned to open surgery because of the large size of tumor.The surgical duration ranged from 35～125 min,with an average of （75±25）min.The introperative blood loss was 10～50 mLapproximately,with an average of（25±10）mL.The time of indwelling stomach tube ranged from 0～24 hours after operation;Intestinal tract function recovery time were 12～36 hours and liquid diet were taken on 72～96 hours after surgery.The patients must stay in bed for 12～24 hours and the postoperative hospital stay were 5～7 days.Results of IHC：CD117（＋）36 cases（92.3%）,CD34（＋）32 cases（82.1%）.Cases of RAO：extremely lower risk 27,lower risk 10,middle risk 2,high risk 0.During follow up of 1 to 42 months,No case had be found plantation or metastasis.Conclusion：Laparoscopic and gastroscopic cooperative surgery（LGCS） for gastric stromal tumor is a quick-located,process optimization,operation time saving,non-invasive,fast recovery,safe and effective therapy,and can be considered as the first choice for patients with the diameter of tumors smaller than 5 cm or difficulty to located only by laparoscopy.The surgery must be performed by experienced special doctors,the accurate location of tumor and proficient coordination of surgery group.