Laparoscopic wedge resection for gastrointestinal stromal tumors of the stomach: Initial experience
Laparoscopic wedge resection for gastrointestinal stromal tumors of the stomach: Initial experience
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DOI：
10.1007/s00595-005-3164-7
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发表时间：
2006-04-01
期刊：
影响因子：
2.5
通讯作者：
Kato, T
中科院分区：
文献类型：
--
作者：
Mochizuki, Y;Kodera, Y;Kato, T
Purose：胃胃肠道间质瘤 (GIST) 的手术现在经常使用腹腔镜方法进行。我们调查了腹腔镜治疗胃GIST的可行性和有效性。方法：我们回顾了2000年4月至2004年4月连续12例接受腹腔镜GIST手术的患者的记录，并将其短期结果与接受开腹手术的患者进行比较。所有腹腔镜楔形切除术均使用吻合器和 3-4 个套管针完成，通常借助术中胃镜检查。我们在术前使用各种诊断方式对所有患者进行了检查，包括超声内镜引导的细针抽吸术（EUS-FNA）。如果肿瘤位于贲门或幽门附近或直径>= 5 cm，则不需要腹腔镜手术。结果：12 例患者中，有 10 例在术前通过 EUS-FNA 获得了 GIST 的特异性诊断。病变的中位直径为2.7cm（范围1.5-4.8cm）。尽管有两名患者出现术中并发症，但无需中转开腹手术，所有患者均能进行肿瘤完整切除，手术切缘均为阴性。中位手术时间为100分钟（范围65-180分钟），与开放手术相似。首次肠胃气排出时间比开放手术后更早，恢复经口摄入的时间间隔也更短。术后未出现渗漏等重大并发症，术后中位住院时间为7天（范围5-12天）。 EUS-FNA 做出的所有诊断均通过切除标本的免疫组织病理学评估得到证实。结论：对于直径 < 5 cm 的胃 GIST，腹腔镜楔形切除术是一种可行的治疗选择。
Purose:Surgery for gastrointestinal stromal tumors (GIST) of the stomach is now frequently performed using a laparoscopic approach. We investigated the feasibility and effectiveness of laparoscopy in the management of GIST of the stomach.Methods:We reviewed the records of 12 consecutive patients who underwent laparoscopic surgery for GIST between April 2000 and April 2004, and compared their short-term outcomes with those of patients who underwent open surgery. All laparoscopic wedge resections were done using stapling devices and 3-4 trocars, often with the aid of intraoperative gastroscopy. We examined all patients preoperatively using various diagnostic modalities, including endoscopic ultrasonography-guided fine-needle aspiration (EUS-FNA). A laparoscopic approach was not indicated if the tumor was located near the cardia or pylorus or if it was >= 5 cm in diameter.Results:A specific diagnosis of GIST was obtained preoperatively by EUS-FNA in 10 of the 12 patients. The median diameter of the lesion was 2.7cm (range, 1.5-4.8cm). Although intraoperative complications were encountered in two patients, conversion to open surgery was not required, and we were able to perform complete tumor excision with negative surgical margins in all patients. The median operative time was 100 min (range, 65-180min), similar to that for open surgery. First flatus was passed earlier, and the interval to resuming oral intake was shorter than after open surgery. No major postoperative complications such as leakage developed, and the median postoperative hospital stay was 7 days (range, 5-12 days). All diagnoses made by EUS-FNA were confirmed by immunohisto-pathological evaluation of resected specimens.Conclusion:Laparoscopic wedge resection is a feasible treatment option for GISTs of the stomach if the lesion is < 5 cm in diameter.