Lee Joo-Ho, Han Ho-Seong, Kim Young-Woo, Min Seog-Ki, Lee Hyeon Kook
Department of Surgery, Medical Research Center, Ewha Woman's University College of Medicine, Seoul, Korea.
J Laparoendosc Adv Surg Tech A. 2003 Dec;13(6):349-53. doi: 10.1089/109264203322656397.
To evaluate the feasibility and efficacy of laparoscopic wedge resection with handsewn closure in gastroduodenal tumors.
Laparoscopic wedge resection was performed in 16 patients with gastroduodenal tumor between May 2000 and December 2002. Every case, except one, was performed via an extragastric approach; a transgastric approach was adopted in a single case. Excision of the lesion was performed manually by means of electrocautery or ultrasonic coagulating shears and closed by manual intracorporeal running suture.
Among the 16 cases, two cases were treated using a laparoscope-assisted method, but there was no case of conversion to open surgery. Mean size of lesions was 27.9 mm in diameter and the mean operation time was 219 minutes. In all cases, a complete tumor excision with negative surgical margins was obtained. The final pathologic diagnoses were ectopic pancreas (4 cases), gastrointestinal stromal tumor (3 cases), leiomyoma (2 cases), adenomyoma (2 cases), tubular adenoma (1 case), Brunner's gland hyperplasia (1 case), carcinoid tumor (1 case), eosinophilic granuloma (1 case), and post-endoscopic mucosectomy state for early gastric cancer (1 case). The average numbers of days to first postoperative oral food intake and hospital stay were 3.1 days and 6.0 days, respectively. There were no postoperative complications.
Laparoscopic wedge resection with handsewn closure should be considered as a valid treatment option for selected gastroduodenal tumors in terms of feasibility, safety, and cost. A more efficient surgical instrument and technique should be developed in future.
评估腹腔镜楔形切除术加手工缝合关闭在胃十二指肠肿瘤中的可行性和疗效。
2000年5月至2002年12月期间，对16例胃十二指肠肿瘤患者实施了腹腔镜楔形切除术。除1例采用经胃途径外，其余病例均采用胃外途径。通过电灼或超声凝固剪手动切除病变，并用手工体内连续缝合关闭。
16例患者中，2例采用腹腔镜辅助方法治疗，但无一例转为开放手术。病变平均直径为27.9毫米，平均手术时间为219分钟。所有病例均实现了肿瘤完整切除，手术切缘阴性。最终病理诊断为异位胰腺（4例）、胃肠道间质瘤（3例）、平滑肌瘤（2例）、腺肌瘤（2例）、管状腺瘤（1例）、布伦纳腺增生（1例）、类癌肿瘤（1例）、嗜酸性肉芽肿（1例）以及早期胃癌内镜下黏膜切除术后状态（1例）。术后首次经口进食的平均天数和住院天数分别为3.1天和6.0天。无术后并发症。
从可行性、安全性和成本方面考虑，腹腔镜楔形切除术加手工缝合关闭应被视为特定胃十二指肠肿瘤的有效治疗选择。未来应开发更高效的手术器械和技术。
