Non-exposed endoscopic wall-inversion surgery for gastrointestinal stromal tumor
Non-exposed endoscopic wall-inversion surgery for gastrointestinal stromal tumor
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DOI：
10.21037/tgh.2018.03.02
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发表时间：
2018-03-01
影响因子：
3
通讯作者：
Seto, Yasuyuki
中科院分区：
文献类型：
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作者：
Mitsui, Takashi;Yamashita, Hiroharu;Seto, Yasuyuki
腹腔镜和内窥镜联合手术（LECS）是一种公认的腹腔镜胃肠道间质瘤（GIST）楔形切除术，具有微创性。我们建立了一种LECS，实现了全层切除，非暴露的内镜壁翻转手术（NEWS），以防止腹膜腔暴露于胃腔内内容物。我们在28例胃GIST患者中采用了这种手术技术。我们未能在最初的两名患者和一名大肿瘤患者（40 mm x 35 mm）中完成NEWS，但成功地进行了手术。虽然推测会发生学习效应，但基于操作时间的减少趋势，中位操作时间为184分钟，表明NEWS仍然是一种耗时的方法。除了食管胃交界处（EGJ）附近外，肿瘤大小或位置无显著差异，横截面周长也无显著差异。NEWS是可行的，似乎是一个很好的选择，特别是对于粘膜溃疡的小GIST，通过打开胃壁进行全层剜出是不可行的。
Laparoscopic and endoscopic cooperative surgery (LECS) is an accepted method of laparoscopic wedge resection, which is minimally invasive, for gastrointestinal stromal tumors (GISTs). We established a type of LECS achieving a full-thickness resection, non-exposed endoscopic wall-inversion surgery (NEWS), in an effort to prevent exposure of the peritoneal cavity to gastric intraluminal contents. We employed this surgical technique in 28 gastric GIST patients. We failed to complete NEWS in the initial two patients and in one patient with a large tumor (40 mm x 35 mm), but otherwise carried out the procedure successfully. Although a learning effect is speculated to occur, based on a decreasing trend in the operation time, the median operation time was 184 minutes showing that NEWS is still a time-consuming method. No significant differences were recognized in tumor size or location, except near the esophagogastric junction (EGJ), nor in the cross-sectional circumference. NEWS is feasible and appears to be a good option, especially for small GISTs with mucosal ulceration rendering full-thickness enucleation by opening of the gastric wall unfeasible.