Hiki Naoki
Gastroenterological Center, Dept. of Gastroenterological Surgery, Cancer Institute Hospital, Japanese Foundation for Cancer Research.
Gan To Kagaku Ryoho. 2011 May;38(5):728-32.
Laparoscopic wedge resections are being applied increasingly for gastric submucosal tumors, such as gastrointestinal stromal tumor (GIST). In spite of this, no defined strategy exists to help the surgeon choose an appropriate laparoscopic technique for an individual on the basis of tumor characteristics such as location or size. We applied a laparoscopy- and endoscopy-cooperative surgery (LECS) for gastric wedge resection that is applicable for submucosal tumor resection independent of the tumor's location and size.
Thirty-eight patients underwent LECS for the resection of gastric submucosal tumors. Both mucosal and submucosal layers around the tumor were circumferentially dissected using endoscopic submucosal dissection (ESD) by intraluminal endoscopy. Subsequently, the seromusclar layers were laparoscopically dissected precisely on the three-quarter cut line around the tumor. The submucosal tumor was then exteriorized to the abdominal cavity and dissected with a standard endoscopic stapling device.
LECS was successful for all cases of dissecting the gastric submucosal tumor. The postoperative course was uneventful in all cases with no anastomosis leakage, stenosis, or bleeding.
LECS for dissection of gastric submucosal tumors such as GIST may be performed safely. In addition, the success of the procedure does not depend on the location of the tumor, such as the esophago-gastric junction or pyloric ring.
腹腔镜楔形切除术越来越多地应用于胃黏膜下肿瘤，如胃肠道间质瘤（GIST）。尽管如此，目前尚无明确的策略可帮助外科医生根据肿瘤的位置或大小等特征为个体选择合适的腹腔镜技术。我们应用了一种腹腔镜与内镜合作手术（LECS）进行胃楔形切除术，该方法适用于黏膜下肿瘤切除，且不受肿瘤位置和大小的影响。
38例患者接受了LECS切除胃黏膜下肿瘤。通过腔内内镜使用内镜黏膜下剥离术（ESD）对肿瘤周围的黏膜层和黏膜下层进行环形剥离。随后，在腹腔镜下精确地在肿瘤周围的四分之三切割线上对浆肌层进行剥离。然后将黏膜下肿瘤拖至腹腔，并用标准的内镜吻合器进行切除。
所有病例中LECS成功切除胃黏膜下肿瘤。所有病例术后病程平稳，无吻合口漏、狭窄或出血。
LECS可安全地用于切除如GIST等胃黏膜下肿瘤。此外，该手术的成功不取决于肿瘤的位置，如食管胃交界或幽门环。
