Ong Evan, Abrams Andrew I, Lee Elizabeth, Jones Carol
Department of Surgery, University of Arizona, Tucson, AZ, USA.
JSLS. 2013 Jul-Sep;17(3):471-5. doi: 10.4293/108680813X13693422522033.
Gastrointestinal stromal tumors (GISTs) are rare mesenchymal tumors that are located specifically in the gastrointestinal tract, with up to 60% of occurrences in the stomach, 30% in the small intestine, and 10% in the esophagus, colon, and rectum. The annual incidence of GISTs is about 15 cases per million, which in the United States equals 5000 cases per year. In most cases, these tumors are asymptomatic and are found incidentally on computed tomography scan or by endoscopy. Preoperative evaluation is based on location, size, and anatomic features and helps to confirm the diagnosis of the GIST and assess outcomes. Surgical intervention is the gold standard for treatment of nonmetastatic GISTs.
We report the case of an 80-year-old man with a gastric mass on the posterior surface of the greater curvature of the stomach at the junction of the gastric antrum and the pylorus, found incidentally on a computed tomography scan. The patient underwent a diagnostic laparoscopy and a single-incision laparoscopic sleeve gastrectomy. After histologic evaluation, the resected lesion was determined to be a gastrointestinal stromal tumor.
A single-incision laparoscopic sleeve gastrectomy for the resection of GISTs is a feasible and appropriate method if the lesion is a safe distance from the pylorus and the gastroesophageal junction for gross negative margins to be obtained. Its advantages include decreased pain and a shorter hospital stay compared with other methods.
胃肠道间质瘤（GISTs）是一种罕见的间充质肿瘤，特异性地位于胃肠道，高达60%发生于胃，30%发生于小肠，10%发生于食管、结肠和直肠。GISTs的年发病率约为每百万人口15例，在美国每年相当于5000例。在大多数情况下，这些肿瘤无症状，在计算机断层扫描或通过内镜检查时偶然发现。术前评估基于肿瘤位置、大小和解剖特征，有助于确诊GIST并评估预后。手术干预是治疗非转移性GISTs的金标准。
我们报告一例80岁男性患者，在计算机断层扫描时偶然发现胃窦与幽门交界处胃大弯后表面有一胃部肿块。患者接受了诊断性腹腔镜检查和单切口腹腔镜袖状胃切除术。经组织学评估，切除的病变被确定为胃肠道间质瘤。
如果病变距幽门和胃食管交界处有安全距离以获得大体阴性切缘，单切口腹腔镜袖状胃切除术用于切除GISTs是一种可行且合适的方法。与其他方法相比，其优点包括疼痛减轻和住院时间缩短。
