Hwang Sun-Hwi, Park Do Joong, Kim Young Hoon, Lee Kyoung Ho, Lee Hye Seung, Kim Hyung-Ho, Lee Hyuk-Joon, Yang Han-Kwang, Lee Kuhn Uk
Department of Surgery, Seoul National University Bundang Hospital, 300 Gumi-dong, Bundang-gu, Seongnam-si, Gyeonggi, Korea.
Surg Endosc. 2009 Sep;23(9):1980-7. doi: 10.1007/s00464-008-9955-3. Epub 2008 May 10.
Laparoscopic partial gastric resection is widely accepted as a treatment for gastric submucosal tumors (SMTs). However, SMTs of either end of the stomach are generally managed by subtotal gastrectomies or total gastrectomies. This study was conducted to evaluate surgical techniques for management of SMTs located at the ends of the stomach.
Among 63 patients who were diagnosed and underwent laparoscopic surgery for gastric SMTs at Seoul National University Bundang Hospital from May 2003 to May 2007, 11 SMTs located at the ends of the stomach were identified. The clinicopathologic results of these 11 SMTs were analyzed.
Laparoscopic partial wedge resections or tumor excisions were successfully performed on all patients except for those who had prepyloric tumors. Six men and five women had SMTs at the ends of the stomach. The patients ranged in age from 21-63 years (mean 43.4 +/- 13.5 years). Of six esophagogastric junctional tumors that showed low, homogeneous contrast enhancement on computed tomography (CT) scans, five were treated by laparoscopic transgastric enucleation and one by tumor-everting resection. One esophagogastric junctional tumor that leaned toward the fundus and showed a 6-cm-diameter endophytic mass with heterogeneous enhancement on CT scan was resected by laparoscopic wedge resection. The mean operation time was 100 min (range 60-210 min). Three laparoscopy-assisted distal gastrectomies and one laparoscopic wedge resection were performed on SMTs located near the prepyloric antrum. There were no intra- or postoperative complications. Duration of postoperative hospital stay ranged from 4-7 days.
Laparoscopic local resection is an effective treatment for SMTs located at the esophagogastric junction and can be used instead of a total or proximal gastrectomy. However, gastrectomies should be considered for SMTs located near the pylorus because of the small volume of the lower third of the stomach.
腹腔镜部分胃切除术被广泛认为是治疗胃黏膜下肿瘤（SMTs）的一种方法。然而，胃两端的SMTs通常采用胃次全切除术或全胃切除术进行处理。本研究旨在评估处理位于胃两端的SMTs的手术技术。
在2003年5月至2007年5月期间于首尔国立大学盆唐医院被诊断并接受腹腔镜手术治疗胃SMTs的63例患者中，确定了11例位于胃两端的SMTs。分析了这11例SMTs的临床病理结果。
除了那些患有幽门前肿瘤的患者外，所有患者均成功进行了腹腔镜部分楔形切除术或肿瘤切除术。6名男性和5名女性在胃两端患有SMTs。患者年龄在21 - 63岁之间（平均43.4 +/- 13.5岁）。在计算机断层扫描（CT）上显示低、均匀对比增强的6例食管胃交界肿瘤中，5例通过腹腔镜经胃摘除术治疗，1例通过肿瘤外翻切除术治疗。1例倾向于胃底且在CT扫描上显示直径6 cm的内生性肿块且强化不均匀的食管胃交界肿瘤通过腹腔镜楔形切除术切除。平均手术时间为100分钟（范围60 - 210分钟）。对位于幽门前窦附近的SMTs进行了3例腹腔镜辅助远端胃切除术和1例腹腔镜楔形切除术。没有术中或术后并发症。术后住院时间为4 - 7天。
腹腔镜局部切除术是治疗位于食管胃交界的SMTs的有效方法，可替代全胃切除术或近端胃切除术。然而，由于胃下三分之一体积较小，对于位于幽门附近的SMTs应考虑行胃切除术。
