Ke Zhong-Wei, Chen Dan-Lei, Cai Jing-Li, Zheng Cheng-Zhu
The Minimally Invasive Surgery Center, Changhai Hospital, Second Military Medical University, Shanghai, China.
J Laparoendosc Adv Surg Tech A. 2009 Dec;19(6):741-4. doi: 10.1089/lap.2009.0166.
Laparoscopic resection of submucosal tumors in the gastric fundus, especially in the posterior wall near the esophagocardiac junction (ECJ), is difficult and time consuming and is and likely to cause esophageal stenosis and splenic injury. In this article, we report an extraluminal laparoscopic wedge-resection (ELWR) that minimizes these problems.
Thirty-seven patients with submucosal tumors in the posterior wall of the gastric fundus received ELWR. The operation consisted of four steps: 1) localization of the tumor, 2) dissection of the omentum, 3) mobilization of the gastric fundus/upper pole of the spleen and exposure of the ECJ, and 4) resection of the gastric fundus with a linear endoscopic gastrointestinal anastomosis stapler.
None of the cases needed conversion to open surgery. Mean postoperative hospital stay was 5.5 +/- 1.0 days. The distance between the tumor and the incision margin ranged from 0.7 to 2.5 cm toward the ECJ. Pathologic examination revealed 7 cases of leiomyomas, 29 cases of stromal tumors (4 were low-grade malignant tumors), and 1 case of neurofibroma. There was no recurrence, metastasis, esophageal stenosis, or any other severe adverse event during the follow-up period (52 +/- 3.1 months).
ELWR is a safe, effective treatment for submucosal tumors in the posterior wall of the gastric fundus.
腹腔镜切除胃底黏膜下肿瘤，尤其是靠近食管胃交界（ECJ）后壁的肿瘤，操作困难且耗时，还可能导致食管狭窄和脾损伤。在本文中，我们报告一种可将这些问题降至最低的腔外腹腔镜楔形切除术（ELWR）。
37例胃底后壁黏膜下肿瘤患者接受了ELWR。手术包括四个步骤：1）肿瘤定位；2）网膜分离；3）胃底/脾上极游离及ECJ暴露；4）使用线性内镜胃肠吻合器切除胃底。
所有病例均无需转为开放手术。术后平均住院时间为5.5±1.0天。肿瘤与切口边缘向ECJ方向的距离为0.7至2.5厘米。病理检查显示7例平滑肌瘤、29例间质瘤（4例为低级别恶性肿瘤）和1例神经纤维瘤。随访期间（52±3.1个月）无复发、转移、食管狭窄或任何其他严重不良事件。
ELWR是治疗胃底后壁黏膜下肿瘤的一种安全、有效的方法。
