腹腔镜下胃食管结合部（EGJ）胃肠间质瘤切除术：如何保护 EGJ。
Laparoscopic resection for gastrointestinal stromal tumors in esophagogastric junction (EGJ): how to protect the EGJ.
机构信息
Department of Gastrointestinal Surgery, Guangdong Provincial Hospital of Chinese Medicine, The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Dade Road No. 111, 510120, Guangzhou, China.
Department of General Surgery, The Second Hospital of Jilin University, Ziqiang Street No. 218, 130041, Jilin, China.
出版信息
Surg Endosc. 2018 Feb;32(2):983-989. doi: 10.1007/s00464-017-5776-6. Epub 2017 Aug 4.
BACKGROUND
Laparoscopic surgery for gastric gastrointestinal stromal tumors (GISTs) is now widely performed. However, laparoscopic resection of GIST in the esophagogastric junction (EGJ) is technically difficult and rarely reported. Herein, we introduce four fashions of laparoscopic resection for EGJ-GIST.
METHODS
A retrospective review of 42 consecutive patients with EGJ-GIST who underwent attempted laparoscopic surgery was conducted. EGJ-GIST was defined as GIST with an upper border of less than 5 cm from the esophagogastric line. Four fashions of laparoscopic resection were performed: fashion A, laparoscopic wedge resection using linear stapler; fashion B, laparoscopic complete resection by opening the stomach wall and closing with suture or linear stapler; fashion C, laparoscopic mucosa-preserving resection; and fashion D, laparoscopic proximal gastrectomy with pyloroplasty and gastric plication. Clinicopathologic characteristics, operative course, and short-term and long-term outcomes were analyzed.
RESULTS
All procedures were completed successfully without operative complications. In 24 of 42 (57.1%) patients, tumors were located in the fundus or greater curvature. Out of those, 70.8% (17/24) received fashion A and 29.2% (7/24) received fashion B. Tumors in 16 of 42 (38.1%) patients were located in the lesser curvature. Of those, 81.3% (13/16) underwent fashion B and 18.7% (3/16) underwent fashion D. One tumor in the anterior stomach wall and one in the posterior wall received fashion C. The mean operative time was 103.8 ± 22.1 min and the mean estimated blood loss was 22.4 ± 13.5 ml. The mean time to flatus was 40.3 ± 12.9 h and the time to fluid intake was 43.2 ± 14.3 h. The mean hospital stay was 4.8 ± 2.1 days.
CONCLUSIONS
Laparoscopic surgery for EGJ-GIST is safe and feasible. The selection of various laparoscopic resection fashions should be chosen based on tumor location and the surgeon's experience.
背景
腹腔镜手术现已广泛应用于胃胃肠间质瘤（GIST）的治疗。然而，腹腔镜治疗食管胃结合部（EGJ）GIST 具有一定的技术难度，目前鲜有报道。本文旨在介绍 4 种腹腔镜治疗 EGJ-GIST 的术式。
方法
回顾性分析 42 例行腹腔镜手术治疗的 EGJ-GIST 患者的临床资料。EGJ-GIST 定义为距 EGJ 线距离小于 5cm 的 GIST。采用 4 种腹腔镜术式：A 式，采用直线切割吻合器行楔形切除术；B 式，打开胃壁，用缝线或直线切割吻合器缝合；C 式，行黏膜下肿瘤切除术；D 式，行近端胃大部切除术+幽门成形术+胃折叠术。分析患者的临床病理特征、手术过程及近期和远期疗效。
结果
所有患者均顺利完成手术，无手术相关并发症。42 例患者中，24 例（57.1%）肿瘤位于胃底或胃大弯，其中 70.8%（17/24）行 A 式手术，29.2%（7/24）行 B 式手术；16 例（38.1%）肿瘤位于胃小弯，其中 81.3%（13/16）行 B 式手术，18.7%（3/16）行 D 式手术；1 例位于胃前壁、1 例位于胃后壁的肿瘤行 C 式手术。手术时间为 103.8±22.1min，术中出血量为 22.4±13.5ml。术后肛门排气时间为 40.3±12.9h，开始经口进食时间为 43.2±14.3h，术后住院时间为 4.8±2.1d。
结论
EGJ-GIST 行腹腔镜手术是安全可行的。术式的选择应根据肿瘤位置和术者经验而定。
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