Analysis on Transumbilical SingleIncision Laparoscopy Combined with Endoscopy in Treatment for 30 Cases with Small Gastric Stromal Tumors_CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Authors：

刘雁军 ¹ , 张抒 ¹ , 孙晓斌 ² , 李云涛 ¹ , 姚欣敏 ¹ , 夏乡 ¹ , 曹齐常 ² , 侯康 ¹

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Keywords：

内镜黏膜下剥离术; 胃间质瘤; 经脐单孔腹腔镜手术; 内镜全层切除术

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目的探讨经脐单孔腹腔镜联合胃镜治疗微小胃间质瘤(gastric stromal tumors, GIST)的可行性和临床疗效。方法回顾性分析我院2010年10月至2011年5月期间行经脐单孔腹腔镜联合胃镜治疗微小GIST 30例患者的临床资料。结果30例病灶直径（1.0±0.2） cm（0.5～2.0 cm），术后病理检查均证实为极低危险程度GIST。 24例在单孔腹腔镜辅助下成功完成内镜黏膜下剥离术（endoscopic submucosal dissection，ESD）； 3例因ESD术中发生胃壁穿孔而改行内镜全层切除术（endoscopic full-thickness resection, EFR），其中2例继续在单孔下完成穿孔修补术，1例于左上腹壁另加一 Trocar，在双孔下完成穿孔修补术；另3例因ESD剥离瘤体困难，改行胃局部切除术，其中2例继续在单孔下完成手术，1例在双孔下完成手术。 ESD成功率为80.0%（24／30），经脐部单孔完成率为93.3%（28/30）。手术时间（87.5±10.3） min （45～150 min）。全组术后（4.3±0.5） d （3～8 d）出院。术后随访期3～7个月（平均4.6个月），均无病变复发。结论经脐部单孔腹腔镜联合胃镜治疗微小GIST是安全可行的，早期疗效令人满意。

Citation： 刘雁军,张抒,孙晓斌,李云涛,姚欣敏,夏乡,曹齐常,侯康. Analysis on Transumbilical SingleIncision Laparoscopy Combined with Endoscopy in Treatment for 30 Cases with Small Gastric Stromal Tumors. CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY, 2011, 18(11): 1209-1211. doi: Copy

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11.	钟芸诗，陈巍峰，秦新裕．内镜黏膜下剥离术治疗消化道固有肌层肿瘤 [J]．中华消化内镜杂志， 2008, 25(1)： 2225.
12.	Canes D, Desai MM, Aron M, et al. Transumbilical singleport surgery: evolution and current status [J]. Eur Urol, 2008, 54(5): 10201029.
13.	Hiki N, Yamamoto Y, Fukunaga T, et al . Laparoscopic and endoscopic cooperative surgery for gastrointestinal stromal tumor dissection [J]. Surg Endosc, 2008, 22(7): 17291735.
14.	Wang L, Ren W, Fan CQ, et al . Fullthickness endoscopic resection of nonintracavitary gastric stromal tumors: a novel approach [J]. Surg Endosc， 2011， 25(2)： 641647.
15.	Zhou PH, Yao LQ, Qin XY, et al . Endoscopic fullthickness resection without laparoscopic assistance for gastric submucosal tumors originated from the muscularis propria [J]. Surg Endosc, 2011， 25(9): 29262931.

1. Fletcher CD, Berman JJ, Corless C, et al. Diagnosis of gastrointestinal stromal tumors: A consensus approach [J]. Int J Surg Pathol, 2002, 10(2): 8189.
2. Nilsson B, Bümming P, MeisKindblom JM, et al. Gastrointestinal stromal tumors: the incidence, prevalence, clinical course, and prognostication in the preimatinib mesylate era—a populationbased study in western Sweden [J]. Cancer, 2005, 103(4): 821829.
3. Liu YJ, Yang Z, Hao LS, et al . Synchronous incidental gastrointestinal stromal and epithelial malignant tumors [J]. Word J Gastroenterol, 2009, 15(16): 19212048.
4. Miettien M， Majidi M， Lasota J． Pathology and diagnostic criteria of gastrointestinal stromal tumors (GISTs)： a review [J]. Enr J Cancer, 2002, 38(5)： 3951.
5. Tornóczky T, Kvér E, Pajor L. Frequent occurrence of low grade cases among metastatic gastrointestinal stromal tumors [J]． J Clin Pathol, 2003, 56(5): 363367.
6. Miettinen M, ElRifai W, Sobin LH, et al. Evaluation of malignancy and prognosis of gastrointestinal stromal tumors: a review [J]. Hum Pathol, 2002, 33(5): 478483.
7. Tanaka J, Oshima T, Hori K, et al. Small gastrointestinal stromal tumor of the stomach showing rapid growth and early metastasis to the liver [J]. Dig Endosc, 2010, 22(4): 354356.
8. 郑成竹, 李际辉. 胃间质瘤的诊断和微创治疗 [J]. 中国普外基础与临床杂志, 2004, 11(3): 199200.
9. 罗国德, 龚加庆, 张林, 等. 腹腔镜胃部分切除术治疗胃间质瘤22例 [J]. 中国普外基础与临床杂志, 2010, 17(10): 10141016.
10. Trcoveanu E, Dimofte G, Vasilescu A, et al. Laparoscopic management of gastrointestinal stromal tumours [J]. Acta Chir Belg, 2010, 110(3): 295302.
11. 钟芸诗，陈巍峰，秦新裕．内镜黏膜下剥离术治疗消化道固有肌层肿瘤 [J]．中华消化内镜杂志， 2008, 25(1)： 2225.
12. Canes D, Desai MM, Aron M, et al. Transumbilical singleport surgery: evolution and current status [J]. Eur Urol, 2008, 54(5): 10201029.
13. Hiki N, Yamamoto Y, Fukunaga T, et al . Laparoscopic and endoscopic cooperative surgery for gastrointestinal stromal tumor dissection [J]. Surg Endosc, 2008, 22(7): 17291735.
14. Wang L, Ren W, Fan CQ, et al . Fullthickness endoscopic resection of nonintracavitary gastric stromal tumors: a novel approach [J]. Surg Endosc， 2011， 25(2)： 641647.
15. Zhou PH, Yao LQ, Qin XY, et al . Endoscopic fullthickness resection without laparoscopic assistance for gastric submucosal tumors originated from the muscularis propria [J]. Surg Endosc, 2011， 25(9): 29262931.

CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Analysis on Transumbilical SingleIncision Laparoscopy Combined with Endoscopy in Treatment for 30 Cases with Small Gastric Stromal Tumors

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