• 解放軍總醫(yī)院第一附屬醫(yī)院普通外科(北京 100048);

目的  探討腹腔鏡與胃鏡聯(lián)合在切除胃間質瘤中的應用價值。
方法  回顧性分析我院2008年6月至2012年6月期間行腹腔鏡聯(lián)合胃鏡治療的45例胃間質瘤患者的臨床資料。
結果  45例患者均在腹腔鏡與胃鏡結合下成功切除胃間質瘤,腫瘤切除完整,邊緣無殘留。手術切口長約4~6cm (平均5.1cm),手術時間40~90min (平均75min),術后恢復順利,未發(fā)生手術相關并發(fā)癥,住院時間5~9d (平均6.8d)。隨訪3~24個月(平均16.5個月),未發(fā)生復發(fā)或轉移。免疫組織化學檢測結果:CD117陽性43例,CD34陽性32例,SMA陽性28例,Desmin陽性2例,S-100陽性22例。
結論  腹腔鏡與胃鏡結合治療胃間質瘤,具有創(chuàng)傷小、手術時間短、術后恢復快等優(yōu)點,同時由于有胃鏡配合可以使切除范圍更加精確,避免腫瘤殘留及切除過多正常胃組織。

引用本文: 姚京,譚向龍,戎世捧,陳峰,朱瑛梅,姚勝. 腹腔鏡聯(lián)合胃鏡治療胃間質瘤45例. 中國普外基礎與臨床雜志, 2013, 20(5): 525-528. doi: 復制

1. Li VK, Wexner SD, Pulido N, et al. Use of routine intraoperativeendoscopy in elective laparoscopic colorectal surgery:can it furtheravoid anastomotic failure?[J]. Surg Endosc, 2009, 23(11):2459-2465.
2. Miettinen M, Sobin LH, Lasota J. Gastrointestinal stromaltumors of the stomach:a clinicopathologic, immunohistochemical,and molecular genetic study of 1 765 cases with long-term follow-up[J]. Am J Surg Pathol, 2005, 29(1):52-68.
3. Blay JY, von Mehren M, Blackstein ME. Perspective on updated treatment guidelines for patients with gastrointestinal stromaltumors[J]. Cancer, 2010, 116(22):5126-5137.
4. Onozato Y, Kakizaki S, Ishihara H, et al. Endoscopic submucosal dissection for rectal tumors[J]. Endoscopy, 2007, 39(5):423-427.
5. Taku K, Sano Y, Fu KI, et al. Iatrogenic perforation associated with therapeutic colonoscopy:a multicenter study in Japan[J]. J Gastroenterol Hepatol, 2007, 22(9):1409-1414.
6. Tanaka S, Oka S, Kaneko I, et al. Endoscopic submucosal dissection for colorectal neoplasia:possibility of standardization[J]. Gastrointest Endosc, 2007, 66(1):100-107.
7. Bertolini V, Chiaravalli AM, Klersy C, et al. Gastrointestinal stromal tumors-frequency, malignancy, and new prognostic factors:the experience of a single institution[J]. Pathol Res Pract, 2008, 204(4):219-233.
8. Nowain A, Bhakta H, Pais S, et al. Gastrointestinal stromal tumors:clinical profile, pathogenesis, treatment strategies and prognosis[J]. J Gastroenterol Hepatol, 2005, 20(6):818-824.
9. 胡旭光, 鄭成竹, 印慨, 等. 腹腔鏡胃間質瘤切除56例體會[J]. 腹腔鏡外科雜志, 2008, 13(4):284-285.
10. 譚玉林, 嚴國度, 法鎮(zhèn)中, 等. 胃間質瘤26例臨床診治分析[J]. 中國癌癥雜志, 2009, 19(7):536-539.
11. 楊海波. 胃惡性間質瘤致失血性休克1例報道[J]. 中國普外基礎與臨床雜志, 2003, 10(4):421.
12. 鄭成竹, 李際輝. 胃間質瘤的診斷和微創(chuàng)治療[J]. 中國普外基礎與臨床雜志, 2004, 11(3):199-200.
13. Rösch T, Sarbia M, Schumacher B, et al. Attempted endoscopic en bloc resection of mucosal and submucosal tumors using insulated-tip knives:a pilot series[J]. Endoscopy, 2004, 36(9):788-801.
14. Krajinovic K, Germer CT, Agaimy A, et al. Outcome after rese-ction of one hundred gastrointestinal stromal tumors[J]. Dig Surg, 2010, 27(4):313-319.
15. Miettinen M, Lasota J. Gastrointestinal stromal tumors-definition,clinical, histological, immunohistochemical, and molecular genetic features and differential diagnosis[J]. Virchows Arch, 2001, 438(1):1-12.
16. 季加孚. 小腸間質瘤的診斷與治療[J]. 臨床外科雜志, 2008, 16(8):509-511.
17. Mochizuki Y, Kodera Y, Fujiwara M, et al. Laparoscopic wedge resection for gastrointestinal stromal tumors of the stomach:initialexperience[J]. Surg Today, 2006, 36(4):341-347.
18. Schäfer H, Schneider PM, Baldus SE, et al. Combined laparoscopic/endoscopic treatment of gastric stroma tumors[J]. Zentralbl Chir, 2006, 131(3):206-209.
19. Silberhumer GR, Hufschmid M, Wrba F, et al. Surgery for gastro-intestinal stromal tumors of the stomach[J]. J Gastrointest Surg, 2009, 13(7):1213-1219.
20. Jeong IH, Kim JH, Lee SR, et al. Minimally invasive treatment of gastric gastrointestinal stromal tumors:laparoscopic and endo-scopic approach[J]. Surg Laparosc Endosc Percutan Tech, 2012, 22(3):244-250.
21. Tsujimoto H, Yaguchi Y, Kumano I, et al. Successful gastric submucosal tumor resection using laparoscopic and endoscopic cooperative surgery[J]. World J Surg, 2012, 36(2):327-330.
22. Wong DC, Wong SK, Leung AL, et al. Combined endolaparoscopic intragastric excision for gastric neoplasms[J]. J Laparoendosc Adv Surg Tech A, 2009, 19(6):765-770.
23. 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.
24. Wilhelm D, von Delius S, Burian M, et al. Simultaneous use of laparoscopy and endoscopy for minimally invasive resection of gastric subepithelial masses-analysis of 93 interventions[J]. World J Surg, 2008, 32(6):1021-1028.
25. Pross M, Wolff S, Schubert D, et al. Combined minimal-invasiveprocedures for resection of benign gastric wall tumors[J]. Zentr-albl Chir, 2003, 128(3):191-194.
26. Novitsky YW, Kercher KW, Sing RF, et al. Long-term outcomesof laparoscopic resection of gastric gastrointestinal stromal tumors[J]. Ann Surg, 2006, 243(6):738-745.
27. 羅蘇明, 韓振魁, 劉妍芳. 胃間質瘤49例臨床資料分析[J]. 新疆醫(yī)學, 2008, 38(9):48-50.
28. 沈清, 袁健, 張金坤. 胃間質瘤32例臨床診治分析[J]. 中國現(xiàn)代醫(yī)藥雜志, 2008, 10(7):28-30.
29. Privette A, Mccahill L, Borrazzo E, et al. Laparoscopic approa-ches to resection of suspected gastric gastrointestinal stromaltumors based on tumor location[J]. Surg Endosc, 2008, 22(2):487-494.
30. 喻學橋, 王道榮, 陳兆雷, 等. 腹腔鏡外科治療胃間質瘤的治療體會[J]. 中國現(xiàn)代普通外科進展, 2009, 12(2):174-175.
31. 楊平, 鄧建中, 程龍慶, 等. 雙鏡聯(lián)合技術在胃間質瘤切除術中的應用[J]. 中華腔鏡外科雜志:電子版, 2010, 3(2):178-181.
  1. 1. Li VK, Wexner SD, Pulido N, et al. Use of routine intraoperativeendoscopy in elective laparoscopic colorectal surgery:can it furtheravoid anastomotic failure?[J]. Surg Endosc, 2009, 23(11):2459-2465.
  2. 2. Miettinen M, Sobin LH, Lasota J. Gastrointestinal stromaltumors of the stomach:a clinicopathologic, immunohistochemical,and molecular genetic study of 1 765 cases with long-term follow-up[J]. Am J Surg Pathol, 2005, 29(1):52-68.
  3. 3. Blay JY, von Mehren M, Blackstein ME. Perspective on updated treatment guidelines for patients with gastrointestinal stromaltumors[J]. Cancer, 2010, 116(22):5126-5137.
  4. 4. Onozato Y, Kakizaki S, Ishihara H, et al. Endoscopic submucosal dissection for rectal tumors[J]. Endoscopy, 2007, 39(5):423-427.
  5. 5. Taku K, Sano Y, Fu KI, et al. Iatrogenic perforation associated with therapeutic colonoscopy:a multicenter study in Japan[J]. J Gastroenterol Hepatol, 2007, 22(9):1409-1414.
  6. 6. Tanaka S, Oka S, Kaneko I, et al. Endoscopic submucosal dissection for colorectal neoplasia:possibility of standardization[J]. Gastrointest Endosc, 2007, 66(1):100-107.
  7. 7. Bertolini V, Chiaravalli AM, Klersy C, et al. Gastrointestinal stromal tumors-frequency, malignancy, and new prognostic factors:the experience of a single institution[J]. Pathol Res Pract, 2008, 204(4):219-233.
  8. 8. Nowain A, Bhakta H, Pais S, et al. Gastrointestinal stromal tumors:clinical profile, pathogenesis, treatment strategies and prognosis[J]. J Gastroenterol Hepatol, 2005, 20(6):818-824.
  9. 9. 胡旭光, 鄭成竹, 印慨, 等. 腹腔鏡胃間質瘤切除56例體會[J]. 腹腔鏡外科雜志, 2008, 13(4):284-285.
  10. 10. 譚玉林, 嚴國度, 法鎮(zhèn)中, 等. 胃間質瘤26例臨床診治分析[J]. 中國癌癥雜志, 2009, 19(7):536-539.
  11. 11. 楊海波. 胃惡性間質瘤致失血性休克1例報道[J]. 中國普外基礎與臨床雜志, 2003, 10(4):421.
  12. 12. 鄭成竹, 李際輝. 胃間質瘤的診斷和微創(chuàng)治療[J]. 中國普外基礎與臨床雜志, 2004, 11(3):199-200.
  13. 13. Rösch T, Sarbia M, Schumacher B, et al. Attempted endoscopic en bloc resection of mucosal and submucosal tumors using insulated-tip knives:a pilot series[J]. Endoscopy, 2004, 36(9):788-801.
  14. 14. Krajinovic K, Germer CT, Agaimy A, et al. Outcome after rese-ction of one hundred gastrointestinal stromal tumors[J]. Dig Surg, 2010, 27(4):313-319.
  15. 15. Miettinen M, Lasota J. Gastrointestinal stromal tumors-definition,clinical, histological, immunohistochemical, and molecular genetic features and differential diagnosis[J]. Virchows Arch, 2001, 438(1):1-12.
  16. 16. 季加孚. 小腸間質瘤的診斷與治療[J]. 臨床外科雜志, 2008, 16(8):509-511.
  17. 17. Mochizuki Y, Kodera Y, Fujiwara M, et al. Laparoscopic wedge resection for gastrointestinal stromal tumors of the stomach:initialexperience[J]. Surg Today, 2006, 36(4):341-347.
  18. 18. Schäfer H, Schneider PM, Baldus SE, et al. Combined laparoscopic/endoscopic treatment of gastric stroma tumors[J]. Zentralbl Chir, 2006, 131(3):206-209.
  19. 19. Silberhumer GR, Hufschmid M, Wrba F, et al. Surgery for gastro-intestinal stromal tumors of the stomach[J]. J Gastrointest Surg, 2009, 13(7):1213-1219.
  20. 20. Jeong IH, Kim JH, Lee SR, et al. Minimally invasive treatment of gastric gastrointestinal stromal tumors:laparoscopic and endo-scopic approach[J]. Surg Laparosc Endosc Percutan Tech, 2012, 22(3):244-250.
  21. 21. Tsujimoto H, Yaguchi Y, Kumano I, et al. Successful gastric submucosal tumor resection using laparoscopic and endoscopic cooperative surgery[J]. World J Surg, 2012, 36(2):327-330.
  22. 22. Wong DC, Wong SK, Leung AL, et al. Combined endolaparoscopic intragastric excision for gastric neoplasms[J]. J Laparoendosc Adv Surg Tech A, 2009, 19(6):765-770.
  23. 23. 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.
  24. 24. Wilhelm D, von Delius S, Burian M, et al. Simultaneous use of laparoscopy and endoscopy for minimally invasive resection of gastric subepithelial masses-analysis of 93 interventions[J]. World J Surg, 2008, 32(6):1021-1028.
  25. 25. Pross M, Wolff S, Schubert D, et al. Combined minimal-invasiveprocedures for resection of benign gastric wall tumors[J]. Zentr-albl Chir, 2003, 128(3):191-194.
  26. 26. Novitsky YW, Kercher KW, Sing RF, et al. Long-term outcomesof laparoscopic resection of gastric gastrointestinal stromal tumors[J]. Ann Surg, 2006, 243(6):738-745.
  27. 27. 羅蘇明, 韓振魁, 劉妍芳. 胃間質瘤49例臨床資料分析[J]. 新疆醫(yī)學, 2008, 38(9):48-50.
  28. 28. 沈清, 袁健, 張金坤. 胃間質瘤32例臨床診治分析[J]. 中國現(xiàn)代醫(yī)藥雜志, 2008, 10(7):28-30.
  29. 29. Privette A, Mccahill L, Borrazzo E, et al. Laparoscopic approa-ches to resection of suspected gastric gastrointestinal stromaltumors based on tumor location[J]. Surg Endosc, 2008, 22(2):487-494.
  30. 30. 喻學橋, 王道榮, 陳兆雷, 等. 腹腔鏡外科治療胃間質瘤的治療體會[J]. 中國現(xiàn)代普通外科進展, 2009, 12(2):174-175.
  31. 31. 楊平, 鄧建中, 程龍慶, 等. 雙鏡聯(lián)合技術在胃間質瘤切除術中的應用[J]. 中華腔鏡外科雜志:電子版, 2010, 3(2):178-181.
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