两镜联合治疗30例胃间质瘤的临床体会

Resection of Gastric Stromal Tumors by Laparoscopy Combined with Gastroscopy: A Report of 30 Cases

  • 摘要: 目的:探讨胃镜联合腹腔镜手术切除胃间质瘤的安全性、可靠性。方法:回顾性总结天津市人民医院消化外科自2004年7 月至2009年3 月共30例胃间质瘤患者采用胃镜联合腹腔镜手术切除的临床病理资料,并进行随访。其中男18例,女12例。结果:30例患者术前经胃镜、超声胃镜、上消化道钡餐造影及腹部CT、腹部核磁共振检查诊断胃间质瘤。瘤体位于胃后壁11例,胃前壁19例;胃底部10例,胃体部16例(大弯侧11例,小弯侧5 例),小弯近贲门1 例,胃窦体交界部3 例。30例手术均获成功,无手术死亡及中转开腹,手术时间40~120min,平均时间70min;术中出血量20~80mL,术后测量肿瘤直径0.7~5.0cm,平均直径1.5cm。术后免疫组化结果为:CD117 阳性28例(93.3%),CD34阳性26例(86.7%)。 术后病理判定肿瘤生物学风险行为结果,极低度风险18例,低度风险9 例,中度风险3 例,高度风险0 例。术后48h 内下床活动、恢复胃肠功能,术后2~3 天进流质饮食,无术后并发症,术后住院4~7 天。术后随访1~36个月,经胃镜复诊,未发现复发及转移。结论:胃间质瘤临床表现缺乏特异性,诊断主要依靠上消化道造影、电子胃镜、超声内镜及CT检查。手术切除是胃间质瘤唯一有效的治疗方法,胃镜联合腹腔镜手术治疗安全、可靠,并发症少,并具有定位准确、创伤小,术后恢复快,疗效确切等优点,值得被广泛推广应用。

     

    Abstract: Objective:To investigate the efficacy of laparoscopic and gastroscopic resection on gastric stromal tumors. Methods:The clinicopathologic data of 30 cases ( 18 males and 12 females) of gastric stromal tumors treated with laparoscopy combined with gastroscopy between July 2004 and March 2009 were retrospectively analyzed. Results: The preoperative diagnosis of gastric stromal tumors mainly relied on gastroscopy ,ultrasound gastroscopy ,barium meal, abdominal CT scan and abdominal MRI. Tumors were located in the posterior wall of the stomach in 11 cases, in the gastric anterior wall in 19cases, in the lower portion of the stomach in 10cases, in the gastric body in 16cases (in the greater curvature side in 11cases and in the lesser curvature in 5 cases), in the small bend of the gastric cardia in 1 case, and in the gastric body at the junction in 3 cases. All surgeries were successfully accomplished, with no death or conversion to laparotomy. The surgical duration was 40-120 min (70min on average), with a blood loss of20mL to80mL. Tumor size ranged from 0.7 cm to 5 cm (1.5 cm on average). Postoperative immunohistochemistry showed positive expression of CD 117 in 28cases (96.6%) and positive expression of CD34in 26cases (86.6%). As to tumor-biological risk, 18cases had very low degree risk, 9 cases had low degree risk, and 3 cases had moderate degree risk. No cases had high degree risk. Within 48h after surgery, patients could get out of bed and gastrointestinal function was restored. Patients had liquid diet at 2-3 days after surgery. No postoperative complications were observed. Postoperative hospital stay was 4-10days. No recurrence or metabasis occurred in all of 30cases during the follow up (1~36months). Conclusion:Clinical manifestation of gastric stromal tumor lacks specificity and its diagnosis relies mainly on upper gastrointestinal imaging, video endoscopy, ultrasound endoscopy, and CT scan. The only effective treatment for gastric stromal tumors is surgical resection. Resection of gastric stromal tumors with laparoscopy combined with gastroscopy is a safe and effective treatment for gastric stromal tumor, with satisfactory positioning accuracy, fewer complications, less trauma, and faster postoperative recovery.

     

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