Clinical analysis of twelve cases with gastric submucosal tumor treated by laparoscopic intragastric surgery
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摘要:目的 分析腹腔镜辅助经胃腔切除术治疗胃黏膜下肿瘤的临床疗效，探讨其安全性、可行性及临床应用价值。方法 回顾性分析自2015年1月至2021年5月湖北民族大学附属民大医院采取腹腔镜辅助经胃腔切除术治疗的12例胃黏膜下肿瘤患者的临床资料，探讨该方法治疗肿瘤胃黏膜下肿瘤的安全性和可行性。结果 12例患者均顺利完成手术，未中转开腹手术。1例患者切除肿瘤时胃壁穿孔，行胃壁楔形切除及胃腔内全层缝合关闭缺损。手术时间为40～120 min，平均80 min；出血量为10～100 mL，平均40 mL。术后无出血、吻合口瘘、贲门狭窄、反酸等并发症发生，术后第1～2天拔除胃管、饮水，术后第2～3天进食流质饮食，引流管留置时间3～5天，住院天数5～7天。术后病理提示1例为平滑肌瘤，余均为间质瘤，肿物直径约17～56 mm，环周切缘5～20 mm。12例术后6～12个月行胃镜检查，见手术部位愈合良好，无溃疡及瘢痕形成，未见肿瘤复发。结论 腹腔镜辅助经胃腔切除术治疗胃黏膜下肿瘤安全、可行，进一步降低了患者手术创伤，较好地保留了器官功能。Abstract:Objective To analyze the clinical efficacy of laparoscopic intragastric surgery (LIGS) for submucosal tumors and explore its safety, feasibility, and clinical application value.Methods The clinical data of 12 patients with submucosal tumors treated by laparoscopic-assisted gastric gas injection in Hubei Minzu University Affiliated Hospital from January 2015 to May 2021 were retrospectively analyzed to evaluate the safety and feasibility of the treatment method for gastric submucosal tumors.Results All 12 cases had successful completion of the surgery, and no abdominal surgery was performed. Gastric wall perforation was observed in one case. Then, intragastric wedge resection was performed, and the defect was closed by full-layer stitching. The surgery time ranged from 40 to 120 min, average time was 80 min; blood loss was 10 to 100 mL, and average blood loss was 40 mL. Postoperatively, no complications, such as bleeding, anastomosis fistula, cardiac stenosis, acid reflux, and other complications occurred. The gastric tube was removed and drinking water was extracted on the first to second day postoperatively, and liquid diet was taken on the second to third day postoperatively. The indwelling time of the drainage tube was 3–5 days, and the length of hospital stay was 5–7 days. Postoperative pathology indicated that one case was leiomyoma, and the rest were stromal tumors with a diameter of 17–56 mm and circumferential resection margin of 5–20 mm. After 6–12 months postoperatively, 12 cases underwent gastroscopy, which showed that the surgical site healed well, without ulcer and scar formation, and no tumor recurrence.Conclusions Laparoscopic-assisted gastric gas injection is safe and feasible in gastric submucosal tumor treatment, which further reduces the surgical trauma of patients and preserves the organ function well.
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图 1 12例患者手术相关影像资料
A：建立腹腔观察孔，直视下确定胃腔操作孔及观察孔位置；B：牵引线辅助下建立胃腔操作孔；C：调整气囊，将胃壁固定于腹壁；D：探查肿瘤形态及位置；E：胃腔操作孔建立完毕；F：超声刀或电凝钩游离肿瘤；G：取物袋装取标本；H：免打结线缝合胃腔内创面；I：手术结束，放置引流，缝合切口。
表 1 12例患者手术及病理资料
序号 肿瘤部位 有无溃疡 手术时间（min） 术中出血（mL） 进食时间（天） 住院时间（天） 有无穿孔 中转手术 病理学 肿瘤直径（cm） 1 胃底 有 120 100 2 6 有 否 高危 5.6 2 胃体后壁 无 75 50 2 5 无 否 极低危 2.2 3 胃体后壁 无 40 25 2 5 无 否 极低危 1.7 4 胃底 无 100 20 2 6 无 否 平滑肌瘤 2.0 5 胃底 无 90 15 3 7 无 否 极低危 1.8 6 胃体小弯 有 65 80 2 6 无 否 中危 4.3 7 贲门附近 无 70 20 2 6 无 否 低危 2.5 8 贲门附近 无 60 20 2 5 无 否 中危 2.7 9 胃底 无 55 55 3 6 无 否 中危 3.0 10 胃窦 无 85 10 2 6 无 否 极低危 2.0 11 贲门附近 无 110 25 2 7 无 否 中危 2.8 12 贲门附近 无 80 30 3 5 无 否 中危 2.4 
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