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目的 探讨腹腔镜下胃局部切除术治疗胃良性肿瘤的临床效果。方法 采用腹腔镜下胃局部切除术治疗91例胃良性肿瘤。根据不同病灶部位，手术方法包括肿瘤剥除、胃楔形切除、经胃腔肿瘤切除。结果 除1例中转开腹外，手术时间30-120min，平均57min。术中出血平均62mL。术后疼痛轻微，1～4d恢复半流饮食，1～5d恢复活动，平均住院时间5．7d。结论 腹腔镜下胃局部切除术治疗胃良性肿瘤具有创伤小、疼痛轻微、术后恢复快、并发症少的优点，具有良好的应用前景。     

腹腔镜胃部分切除术15例的体会

目的 :探讨腹腔镜胃大部切除术的方法及优缺点。方法 :为 15例患者行腹腔镜胃部分切除术。结果 :15例均成功完成手术 ,行B -Ⅱ式胃大部分切除术 12例 ,其中 1例术中切断胃体时因切割器故障中转开腹 ;胃局部楔形切除 1例 ;胃恶性肿瘤根治切除 2例。手术时间 2 10 5min(14 0～ 2 80min)术中平均出血10 0ml。无并发症发生 ,术后 7 8(5～ 10d)出院。胃恶性肿瘤术后随访 1～ 12月 ,无复发转移。结论 :腹腔镜胃切除术患者安全 ,创伤小 ,恢复快     

腹腔镜手术治疗胃间叶源性肿瘤的临床研究

目的:探讨腹腔镜手术治疗胃间叶源性肿瘤的临床应用价值。方法:回顾性分析2008年3月至2010年10月间接受腹腔镜手术的35例胃间叶源性肿瘤病人的临床资料,包括手术方式、手术时间、术中出血量、术后住院时间、并发症、术后病理及随访结果等。结果:所有手术均在腹腔镜下完成,其中使用内镜下线型切割闭合器行腹腔镜胃部分切除术27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4例。8例手术采用术中胃镜的双镜治疗。无一例中转开腹手术。中位手术时间90(60~160)min,术中平均出血量(42.1±23.6)(10~200)mL,肿瘤平均大小(35.4±13.5)(10~62)mm,肿瘤切缘术中冷冻及术后石蜡病理均为阴性。术后病理胃间质瘤26例、胃神经鞘瘤5例、胃平滑肌瘤2例、胃脉管瘤1例、胃纤维母/肌纤维母细胞瘤1例。术后平均住院时间(6.3±1.3)(4~10)d,无术后并发症。术后中位随访时间22(12~43)个月,所有病人均无肿瘤复发及远处转移。结论:腹腔镜手术切除胃间叶源性肿瘤是安全、微创、有效的,应作为此类肿瘤治疗的首选方法。     

腹腔镜胃基质瘤切除术：附32例报告

目的:探讨腹腔镜胃基质瘤切除术的临床应用价值。方法:回顾性总结32例采用腹腔镜方法治疗胃基质肿瘤患者的临床资料。肿瘤直径1.5~5.5 (平均2.6) cm。手术方式主要为腹腔镜下胃肿瘤切除术、腹腔镜辅助和手助腹腔镜下胃肿瘤切除术。结果:32例均手术均顺利完成。平均手术时间75min，术中平均出血50mL。术后疼痛轻微，术后排便、排气时间平均为34h，术后平均住院天数为7.5d。术后病理证实25例为良性基质瘤， 7例为低度恶性基质瘤。随访8~30个月未见复发。结论:腹腔镜下胃基质瘤切除术是一种安全、有效的微创手术方法，值得临床推广应用。     

胃造口法腹腔镜胃后壁黏膜下肿瘤切除术的临床应用

目的探讨胃造口法腹腔镜胃后壁黏膜下肿瘤切除术的临床应用价值。方法回顾性总结42例胃肿瘤患者采用此法治疗的临床资料,包括病灶位于胃体后壁23例,胃底后壁19例;肿瘤直径1.5～5.2(平均2.4)cm。术式主要步骤为病灶定位、胃前壁切开、肿瘤提出胃腔、肿瘤切除、前壁缝合。结果41例手术获得成功,平均手术时间68min,平均术中出血25ml。术后疼痛轻微,术后第1天可恢复活动,第3天恢复进食,平均住院天数7.4d。有5例患者术后病理显示为低度恶性间质瘤,随访10～48个月未见复发。结论胃造口法腹腔镜胃后壁黏膜下肿瘤切除术是一种简便、安全、有效的微创手术方法,值得临床推广应用。     

胃食管交界区黏膜下肿瘤腹腔镜手术体会(附5例报告并文献复习)

目的:探讨腹腔镜胃局部切除术治疗胃食管交界区黏膜下肿瘤的可行性。方法:回顾性分析2005年3月至2008年3月5例行腹腔镜手术的胃食管交界区黏膜下肿瘤患者的手术方式设计,术后定期随访。结果:平均手术时间(108±19.5)min,术中平均出血(65±11.7)ml;5例手术均获成功,无病灶遗漏,无贲门狭窄、腹腔感染、脾脏损伤、胃漏等并发症和中转手术;术后随访均未见肿瘤复发。结论:腹腔镜胃局部切除术治疗胃食管交界区黏膜下肿瘤安全、有效。     

腹腔镜下胃底黏膜下肿瘤切除术

目的 评价腹腔镜下胃腔外胃底楔形切除术的可行性与安全性.方法 总结分析2000年9月至2006年12月行腹腔镜下胃底切除术的84例患者的临床资料.该术式采用4孔法,手术主要步骤包括肿瘤定位、网膜游离、胃底和脾上极分离、食管贲门连接处(ECJ)显露以及用内视镜直线切割缝合器楔形切割胃底等.结果 患者平均年龄59岁(32～78岁).平均肿瘤直径(4.2±1.3)cm;肿瘤边缘距离ECJ 1.1～3.0 cm.84例手术均获成功,手术时间(62.6±8.9)min;术中出血(86.2±8.1)ml.无病灶遗漏,亦无并发症和手术中转.术后平均住院(5.6±0.5)d.66例患者于术后36 h内恢复胃肠功能,并开始进食和下床活动.肿瘤与切缘的距离:与ECJ距离0.7～2.5 cm[(1.4±0.5)cm];与另三面距离2.5～6.0 cm[(4.1±1.0)cm].84例中,平滑肌瘤29例,各型间质瘤51例,神经纤维瘤4例.平均随访(51.0±4.3)个月,无复发和转移发生.结论 腹腔镜胃腔外胃底楔形切除术对胃底,尤其是后壁邻近ECJ黏膜下肿瘤是安全、简便和有效的,可避免腹腔污染、脾脏损伤以及术后食管狭窄的发生;同时,胃的切除范围也不受限.     

腹腔镜下切除胃问质瘤25例报告

目的探讨腹腔镜下个体化治疗胃间质瘤的可行性和安全性。方法2008年7月～2011年11月对25例胃间质瘤行腹腔镜下个体化切除。1例位于贲门,直径6．5cm行腹腔镜辅助近端胃切除术;1例位于胃窦前壁,直径4．5cm,行腹腔镜辅助远端胃切除术;16例位于胃底及胃体,直径2．0—5．5cm,肿瘤充分游离后行腹腔镜下楔形切除术;7例胃后壁腔内型肿瘤,直径2．8～5．0cm,行腹腔镜经胃肿瘤外翻切除术。结果25例均在腹腔镜下完整切除肿瘤。平均手术时间84min（53～165min）,平均术中出血量48ml（20—140m1）。标本切缘未见肿瘤残留,术后病理及免疫组化检查证实为间质瘤,CDll7阳性25例,CD34阳性21例。术后除1例出现胃动力功能障碍,余胃肠功能恢复良好,无胃出血、狭窄及胃漏。术后平均住院8d（6—13d）。24例随访3～36个月（中位随访时间15个月）,生存良好,无复发、转移。结论腹腔镜下胃间质瘤个体化的胃部分切除术可行、安全。     

腹腔镜辅助下进展期胃癌根治术的临床应用(附47例报告)

目的 研究腹腔镜在进展期胃癌中根治术能否满足胃癌手术切缘及D2淋巴结清扫的根治要求.方法 对47例行腹腔镜辅助下胃癌根治术的进展期胃癌患者的临床资料进行回顾性分析.结果 腹腔镜辅助下根治性近端胃大部切除术25例,根治性远端胃大部切除术11例,全胃根治术10例,1例中转开腹;手术时间(220±55)min,术中出血(150±87)ml.术后肛门排气时间、下床活动时间、术后住院时间分别为(5.1±0.5)d、(3.2±0.8)d、(9.0±1.5)d;腹腔镜辅助远端胃大部切除术11例,手术时间(284±37)min,术中出血(120±70)ml.术后肛门排气时间、下床活动时间、术后住院时间分别为(4.0±0.8)d、(3.2±1.5)d、(9.0±2.0)d.腹腔镜辅助全胃切除术10例,手术时间(330±50)min,术中出血(240±65)ml.术后肛门排气时间、下床活动时间、术后住院时间分别为(4.1±0.8)d、(3.2±0.8)d、(9.5±2.0)d.淋巴结清扫平均数(21.95±9.88)个,近端切缘与肿瘤距平均距离(6.41±2.13)cm;远端切缘与肿瘤平均距离(6.22±1.98)cm.无术中及术后并发症,近期疗效良好.结论 腹腔镜在进展期胃癌中根治术是安全可行的,能达到胃癌标准根治术(D2)的淋巴结清扫范围和肿瘤切缘,远期疗效有待进一步观察.     

61例腹腔镜胃手术的经验总结

总结61例腹腔镜胃手术的治疗效果。方法:1992年12月至1999年1月,61例腹腔镜胃手术者中,B-Ⅱ式胃大部切除术17例,B-Ⅰ式胃大部切除术1例,近端胃次全切除术2例,高选择性迷走神经切断术5例,胃造瘘术3例,胃壁良性肿瘤切除术33例。54例行全腹腔镜下胃手术,7例行腹腔镜辅助下胃手术。结果:本组有2例早期胃癌行腹腔镜根治术,至今存活4.6年以上;并发症2例,分别通过再手术和内镜治愈;手术用时35～310min,平均164.2min;术中出血50～500ml,平均218.3ml;住院4～11d,平均6.8d;86％病人于术后48h内恢复胃肠功能;仅4例术后使用止痛剂。结论:只要合理使用、严格掌握手术适应证,腹腔镜胃手术可以取得良好效果。     

双镜联合治疗早期胃癌的临床体会

目的:探讨胃镜、腹腔镜双镜联合治疗早期胃癌的安全性与可行性。方法:回顾分析近6年双镜联合治疗78例早期胃癌患者的临床资料。胃体、远端胃肿瘤非溃疡患者行内镜黏膜下剥离术,近端胃及胃体、远端胃肿瘤合并溃疡患者行双镜联合下腹腔镜胃楔形切除术。标本送快速病理检查。结果:为早期胃癌浸润至黏膜下层及肌层、伴有脉管癌栓、肿瘤直径>20 mm、低分化腺癌(包括印戒细胞癌)的30例患者行腹腔镜胃癌D2根治术,5例近贲门或幽门部位肿瘤患者行单纯胃大部切除术,43例患者仅行内镜黏膜下剥离术或单纯胃楔形切除术。根治患者术后淋巴结转移占全部病例的11.5%,术后均无并发症发生,患者痊愈出院。结论:双镜联合治疗早期胃癌安全、患者创伤小、康复快、疗效确切,更加体现了微创优势,避免了部分患者不必要的根治切除甚至全胃切除的痛苦,值得临床推广。     

Laparoscopic and endoscopic cooperative surgery for gastrointestinal stromal tumor dissection

BACKGROUND: Laparoscopic wedge resections are increasingly applied for gastric submucosal tumors such as gastrointestinal stromal tumor (GIST). Despite this, no defined strategy exists to guide the surgeon in choosing the appropriate laparoscopic technique for an individual case on the basis of tumor characteristics such as location or size. This study aimed to introduce a laparoscopic and endoscopic cooperative surgery (LECS) for gastric wedge resection that is applicable for submucosal tumor resection independent of tumor location and size. METHODS: Seven patients underwent LECS for the resection of gastric submucosal tumors. Both mucosal and submucosal layers around the tumor were circumferentially dissected using endoscopic submucosal dissection via intraluminal endoscopy. Subsequently, the seromusclar layer was laparoscopically dissected on the exact three-fourths cut line around the tumor. The submucosal tumor then was exteriorized to the abdominal cavity and dissected with a standard endoscopic stapling device. RESULTS: In all cases, the LECS procedure was successful for dissecting out the gastric submucosal tumor. In four of seven cases, the tumor was located in the upper gastric portion near the esophagogastric junction. The remaining three tumors were in the posterior gastric wall. In two cases, the tumors were more than 5 cm in diameter, and one was a GIST of the remnant stomach. The mean operation time was 169 +/- 17 min, and the estimated blood loss was 7 +/- 2 ml. The postoperative course was uneventful in all cases. CONCLUSIONS: The LECS procedure for dissection of gastric submucosal tumors such as GIST may be performed safely with reasonable operation times, less bleeding, and adequate cut lines. In addition, the success of the procedure does not depend on the tumor location such as the vicinity of the esophagogastric junction or pyloric ring.     

Ileal Adenomyoma Accompanied by Primary Peritonitis: Report of a Case

We report herein the case of a 52-year-old woman who presented with severe abdominal pain and a 2-week history of a yellow vaginal discharge. An emergency operation was performed for localized peritonitis attributed to acute perforated appendicitis. There were no findings to indicate the cause of peritonitis, but by chance, a submucosal tumor was found in the ileum 2 m from Bauhin's valve. Appendectomy and wedge resection of the ileum with the submucosal tumor were carried out. The peritonitis was considered to have been idiopathic from bacterial and molecular biological examination of the ascites. Pathological, immunohistochemical, and flow cytometrical findings of the resected ileal submocosal tumor indicated a diagnosis of ileal adenomyoma with no malignancy, which suggested metaplasia of the pancreaticobiliary to gastric epithelium. Received: August 4, 2000 / Accepted: January 9, 2001     

Limited resection for early esophageal cancer?

BACKGROUND: Early squamous cell carcinoma (SCC) and early adenocarcinoma (AC) of the esophagus are potentially curable diseases. The crucial point in treatment is that the depth of tumor infiltration into the mucosal and submucosal layers is correlated with the rate of nodal metastases and therefore with long-term prognosis. METHODS AND FOCUS: In submucosal SCC with a high rate of nodal metastases curative resection can be achieved only by radical esophagectomy with systematic lymphadenectomy, which remains the treatment of choice for this tumor entity. In submucosal AC the Merendino procedure may offer an alternative since lymphatic invasion occurs at a later stage than in SCC, and locoregional lymph nodes can be adequately resected. Major advantages of this operation over radical esophagectomy include the complete resection of the entire Barrett segment and the lower postoperative morbidity and mortality. Vagal-sparing esophagectomy still lacks adequate oncological evaluation for it to be recommended except in stage I a tumors. For mucosal SCC and AC endoscopic mucosal resection is the treatment of choice but requires intensive follow-up since the rate of complete resections is lower than in limited and radical surgical procedures. On the other hand, a low postoperative morbidity and the functional integrity of the tubular esophagus support the use of endoscopic mucosal resection for mucosal cancer.     

Second primary carcinoma in the gastric tube constructed as an esophageal substitute after esophagectomy

BACKGROUND: The prognosis of esophageal carcinoma has improved, but along with this improvement, concern has increased about the occurrence of second primary carcinoma, especially gastric carcinoma, in tubes constructed from the stomach after esophagectomy. We describe our experience in the diagnosis and treatment of gastric tube carcinoma. STUDY DESIGN: We retrospectively examined 31 cases of gastric tube carcinoma; these cases occurred in 26 patients who received esophagectomy between September 1968 and October 2000. RESULTS: Surgical resection was performed in 10 patients. Gastrectomy with regional lymph node dissection was performed in 7 patients and partial resection of the stomach without lymph node dissection in 3 patients. In 6 patients leakage was encountered after gastrectomy; 3 of these patients died of multiple organ failure. Only one of the gastrectomy patients is alive without disease. Over the past 7 years, 15 patients with 20 lesions have been treated by endoscopic mucosal resection (EMR). Three of these patients required additional operation because of massive submucosal invasion by the tumor. One complication occurred at EMR, but it was successfully treated by conservative therapy. All patients treated by EMR alone were alive with neither local nor distant metastasis during a median followup period of 27.5 months. Of those patients who received surgical resection initially and were diagnosed as inoperable, all 10 had not received periodic checkups and had some symptoms. In contrast, of 15 patients who underwent EMR, all 20 lesions were found by annual followup endoscopic examination in the absence of symptoms. CONCLUSIONS: EMR for gastric tube carcinoma is safe and has few complications, in contrast to surgical resection of the gastric tube, which places a severe burden on the patient and has high morbidity and mortality. Early detection of the tumor by annual endoscopic examination is recommended for achieving good outcomes in gastric tube carcinoma after esophagectomy.     

Synchronous mucosa-associated lymphoid tissue lymphoma and gastrointestinal stromal tumor of the stomach presenting with gastric bleeding

We report an extraordinarily rare case of synchronous mucosa-associated lymphoid tissue lymphoma and gastrointestinal stromal tumor of the stomach. An 80-year-old man presented with gastric bleeding. Gastroscopy showed an ulcerative lesion and a submucosal tumor at the upper corpus of the stomach. The ulcerative lesion was proven by biopsy to be mucosa-associated lymphoid tissue lymphoma, but the submucosal tumor could not be diagnosed. Due to the repeating episodes of massive gastric bleeding, a total gastrectomy with lymphadenectomy was performed. After the operation, the submucosal tumor was pathologically proven to be a gastrointestinal stromal tumor. In this case, synchronous occurrence of mucosa-associated lymphoid tissue lymphoma and gastrointestinal stromal tumor seems to be coincidental rather than related with the same pathogenic triggering. Surgical resection of the stomach provided an accurate diagnosis and an effective treatment.     

Long-term outcome of laparoscopic wedge resection for gastric submucosal tumor compared with open wedge resection

Little is known about the outcomes of laparoscopic wedge resection (LWR) in comparison with conventional open wedge resection (OWR) for gastric submucosal tumor. Outcomes of 21 patients who underwent LWR (n = 14) or OWR (n = 7) for gastric submucosal tumor between 1993 and 2004 were investigated. We compared the short-term and long-term operative results between the 2 groups. LWR showed several advantages over OWR for gastric submucosal tumor: less blood loss, lower fever on day 1, lower analgesic usage rate, earlier first postoperative flatus and oral intake, lower leukocyte count on days 1 and 7, and lower C-reactive protein level on days 1 and 3. All patients, except 2 with histologically diagnosed high-risk gastrointestinal stromal tumor, survived during the mean follow-up period of 60 months. LWR is feasible for the management of patients with gastric submucosal tumor.