Dong Hai-Yan, Wang Yu-Long, Jia Xin-Yong, Li Jie, Li Guo-Dong, Li Yan-Qing
Department of Endoscopy, Qianfoshan Hospital Affiliated to Shandong University, Jinan, China,
Surg Endosc. 2014 May;28(5):1447-53. doi: 10.1007/s00464-013-3375-8. Epub 2014 Mar 27.
This study aimed to evaluate the feasibility and security of the modified laparoscopic intragastric surgery (MLIGS) and the endoscopic full-thickness resection (EFR) for the treatment of gastric stromal tumors (GSTs) originating from the muscularis propria.
The study population was 18 patients with GSTs of the intraluminal muscularis propria layer. Eight were treated by MLIGS performed according to the following procedures: (1) gastroscopy was used to expose and confirm the location of the tumor; (2) a laparoscope light was placed in the cavity using the trocar at the navel, with the remaining two trocars penetrating both the abdominal and stomach walls; (3) the operation was performed in the gastric lumen using laparoscopic instruments with gastroscope monitoring, and the tumor was resected; (4) the tumor tissue was removed orally using a grasping forceps; (5) and the puncture holes and perforation in the stomach were sutured using titanium clips. The remaining 10 patients were treated by EFR, which involved (1) injection of normal saline into the submucosa and precutting of the mucosal and submucosal layer around the lesion, (2) a circumferential incision as deep as the muscularis propria around the lesion, (3) an incision into the serosal layer around the lesion, (4) completion of full-thickness incision to the tumor, (5) closure of the gastric wall defect with clips.
The GSTs all were resected completely. The two groups did not differ significantly in terms of tumor size, hospital stay, or abdominal pain time. But in the MLIGS group, the operation time and blood loss were significantly decreased compared with the EFR group. No postoperative complications occurred in the MLIGS group, whereas one peritoneal abscess occurred in the EFR group. The pathology of all the resected specimens showed GST. No case of implantation or metastasis was found.
Both MLIGS and EFR are feasible and effective treatments for GSTs from the muscularis propria. Moreover, both are minimally invasive.
本研究旨在评估改良腹腔镜胃内手术（MLIGS）和内镜全层切除术（EFR）治疗起源于固有肌层的胃间质瘤（GSTs）的可行性和安全性。
研究对象为18例固有肌层腔内GSTs患者。8例采用MLIGS治疗，手术步骤如下：（1）通过胃镜暴露并确认肿瘤位置；（2）经脐部套管针将腹腔镜光源置入胃腔，其余两根套管针穿透腹壁和胃壁；（3）在胃镜监测下使用腹腔镜器械在胃腔内进行手术，切除肿瘤；（4）用抓钳经口取出肿瘤组织；（5）用钛夹缝合胃壁穿刺孔和穿孔。其余10例患者采用EFR治疗，步骤包括：（1）向黏膜下层注射生理盐水并在病变周围预切开黏膜和黏膜下层；（2）在病变周围环形切开至固有肌层；（3）在病变周围切开浆膜层；（4）完成肿瘤全层切开；（5）用钛夹封闭胃壁缺损。
所有GSTs均被完全切除。两组在肿瘤大小、住院时间或腹痛时间方面无显著差异。但MLIGS组的手术时间和失血量与EFR组相比显著减少。MLIGS组未发生术后并发症，而EFR组发生1例腹腔脓肿。所有切除标本的病理检查均显示为GSTs。未发现种植或转移病例。
MLIGS和EFR都是治疗固有肌层GSTs的可行且有效的方法。此外，两者均为微创手术。
