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。

Laparoscopic surgery of gastric mesenchymal tumors

Objective To evaluate laparoscopic resection for gastric mesenchymal tumors.Methods From Mar 2008 to Oct 2010,35 patients with gastric mesenchymal tumors underwent laparoscopic gastric resection were retrospectively reviewed.The surgical procedure,operative time,blood loss,post-operative hospital stay,complications,pathology and survey results were analyzed.Results All the patients underwent laparoscopic gastric resection successfully without conversion to open surgery.Twenty-seven patients were subjected to laparoscopic partial gastric resection with an endoscopic linear stapler,4 cases laparoscopy-assisted distal gastrectomy and 4 cases laparoscopy-assisted proximal gastrectomy.Gastroscopy was performed intro-operatively in 8 patients.The median operative time was 90(60-160) min.Blood loss was(42.1±23.6)(10-200) mL.The mean tumor size was(35.4±13.5)(10-62) mm.Negative surgical margins were confirmed by both frozen and final pathologic evaluation.Twenty-six patients(74.2%) had gastric stromal tumors according to the pathologic diagnosis.The remaining tumors consisted of five schwannomas,two leiomyomas,one haemangioma and one fibroblastic/myofibroblastic tumor.The post-operative hospital stay was(6.3±1.3)(4-10) d.No operative complication occurred in any case.After an average of 22(12-43) months follow-up,there was no recurrence or metastasis.Conclusions Laparoscopic gastric resection is a safe,effective and minimally invasive surgery for the treatment of mesenchymal tumors.