Egawa Tomohisa, Kenmochi Takeshi, Irino Tomoyuki, Mihara Koki, Okamura Akihiko, Eto Eiichi, Inaba Yusaku, Murakawa Masaaki, Segami Kenki, Ito Yasuhiro, Nagashima Atsushi
Dept. of Surgery, Digestive Disease Center, Saiseikai Yokohamashi Tobu Hospital.
Gan To Kagaku Ryoho. 2011 Nov;38(12):1960-2.
Because gastric submucosal tumors can be treated by local resection without lymph-node dissection, laparoscopic local resection is widely used to manage relatively small tumors less than 5 cm in diameter. On the other hand, single-incision laparoscopic surgery (SILS) to perform laparoscopic cholecystectomy was feasible. SILS requires only a single incision in the umbilical region; it has better cosmetic outcomes than conventional laparoscopic surgery. The relative difficulty and ease of local gastric resection depends to a large part on tumor location and morphologic characteristics. Extraluminal submucosal tumor of the stomach can be locally resected by SILS using an automated suturing device regardless of tumor location. Intraluminal tumor located in the greater curvature of the gastric body can be treated by SILS, whereas intraluminal lesions located in the lesser curvature and near the gastric cardia or pylorus are difficult to manage by SILS. Laparoscopic and endoscopic cooperative surgery (LECS) is useful for resecting an appropriate amount of tissue at any site. In patients with lesions located near the gastric cardia or pylorus, closure with an automatic suture device may be difficult. Such patients should be switched to reduced-port surgery with a coaxial port, and hand-sewn closure is useful.
由于胃黏膜下肿瘤可通过局部切除而非淋巴结清扫进行治疗，腹腔镜局部切除术被广泛用于处理直径小于5 cm的相对较小肿瘤。另一方面，单孔腹腔镜手术（SILS）用于实施腹腔镜胆囊切除术是可行的。SILS仅需在脐部区域做一个切口；其美容效果优于传统腹腔镜手术。局部胃切除术的相对难易程度在很大程度上取决于肿瘤位置和形态特征。无论肿瘤位置如何，胃腔外黏膜下肿瘤均可通过SILS使用自动缝合装置进行局部切除。位于胃体大弯侧的腔内肿瘤可通过SILS治疗，而位于胃小弯侧以及靠近贲门或幽门的腔内病变则难以通过SILS处理。腹腔镜与内镜联合手术（LECS）对于在任何部位切除适量组织都很有用。对于病变位于贲门或幽门附近的患者，使用自动缝合装置进行闭合可能困难。此类患者应改为使用同轴端口的减孔手术，手工缝合闭合是有效的。
