Hirahara Noriyuki, Matsubara Takeshi, Kidani Akihiko, Hyakudomi Ryoji, Fujii Yusuke, Tajima Yoshitsugu
Department of Digestive and General Surgery, Shimane University Faculty of Medicine , Shimane, Japan .
J Laparoendosc Adv Surg Tech A. 2014 Oct;24(10):707-11. doi: 10.1089/lap.2014.0184. Epub 2014 Sep 2.
The laparoscopic approach would be difficult to perform without causing deformation of the stomach in managing gastrointestinal stromal tumors (GISTs) of the intraluminal type, especially in those that are located in the posterior gastric wall or around the gastroesophageal junction and the pylorus, because intraluminal GISTs usually require an excessive resection of the gastric wall for cure. We present a novel surgical technique for successful management of intraluminal gastric GISTs that minimizes deformation of the stomach regardless of tumor location.
The operating surgeon handles the tumor by holding tissue surrounding the tumor and performs seromyotomy using an ultrasonically activated device along the outer edge of the tumor. The tumor gradually protrudes like an extraluminal tumor as the seromyotomy proceeds. When seromyotomy along the tumor comes up to the point where the tumor sufficiently turns over the gastric serosa, the tumor looks like a pedunculated extraluminal GIST. Two seromuscular sutures are applied to close the exfoliated seromuscular layer. The tips of two seromuscular sutures are held and then pulled up toward the ventral side so that the staple line is aligned in line with the minor axis of the stomach. Finally, complete tumor removal with minimal seromuscular resection is accomplished by applying a linear stapler.
All patients resumed oral ingestion on the day after surgery and showed no signs of anastomotic constriction or obstruction.
Our laparoscopic procedure for gastric GISTs is simple and allows us easy and precise removal of the tumor and closure of the gastric wall with minimum necessary resection, regardless of the location and growth form of the tumors.
在处理腔内型胃肠道间质瘤（GIST）时，尤其是位于胃后壁或胃食管交界处及幽门周围的肿瘤，腹腔镜手术很难在不引起胃变形的情况下进行，因为腔内型GIST通常需要过度切除胃壁才能治愈。我们提出一种新的手术技术，用于成功处理腔内型胃GIST，无论肿瘤位置如何，均可将胃变形降至最低。
手术医生通过握住肿瘤周围的组织来处理肿瘤，并使用超声激活设备沿肿瘤外缘进行浆肌层切开术。随着浆肌层切开术的进行，肿瘤逐渐像腔外型肿瘤一样突出。当沿肿瘤的浆肌层切开术进行到肿瘤充分翻转胃浆膜的程度时，肿瘤看起来像有蒂的腔外型GIST。应用两根浆肌层缝线关闭剥脱的浆肌层。握住两根浆肌层缝线的末端，然后向上拉向腹侧，使吻合线与胃的短轴对齐。最后，通过应用线性吻合器以最小的浆肌层切除完成肿瘤的完整切除。
所有患者术后次日即恢复经口进食，未出现吻合口狭窄或梗阻的迹象。
我们的腹腔镜胃GIST手术方法简单，无论肿瘤的位置和生长形式如何，都能让我们轻松、精确地切除肿瘤并以最小的必要切除闭合胃壁。
