Kim In-Kyeong, Park Ji-Ho, Lee Young-Joon, Jeong Sang-Ho, Kim Tae Han, Kim Dong-Hwan, Kim Han-Gil, Cho Jin-Kyu, Kim Jae-Myung, Kwag Seung-Jin, Kim Ju-Yeon, Jeong Chi-Young, Ju Young-Tae, Jung Eun-Jung, Hong Soon-Chan
Department of Surgery, Gyeongsang National University Hospital, College of Medicine, Gyeongsang National University, Jinju, Korea.
Department of Surgery, Gyeongsang National University Changwon Hospital, College of Medicine, Gyeongsang National University, Changwon, Korea.
J Minim Invasive Surg. 2020 Dec 15;23(4):172-178. doi: 10.7602/jmis.2020.23.4.172.
A novel resection method, namely, laparoscopic local resection through subserosal dissection with endoscopic air-insuff lation (LRSDEA) was used for submucosal tumors located near the esophagogastric junction (SMT-EGJ) to avoid major gastric resection.
A total of 9 cases underwent LRSDEA. We sequentially performed: laparoscopic dissections around EGJ, subserosal dissections around SMTs using laparoscopic electrocautery and ultrasonic shears, and finally, enucleation of SMTs. During these procedures, intraoperative endoscopic tumor localization, as well as endoscopic air-insufflation allowed for safe resection. These procedures are shown in the supplementary video clip. The clinicopathological characteristics and surgical results were analyzed.
All laparoscopic procedures were successfully performed without requiring a major gastrectomy. The mean operation time was 126.1 minutes, and estimated blood loss was 12.0 ml. There were no postoperative complications. Pathological diagnoses were 6 leiomyomas, 2 gastrointestinal stromal tumors, and 1 gastric duplication.
LRSDEA is an effective and safe treatment option for SMT-EGJ, as major resection of the stomach is avoided.
采用一种新型切除方法，即通过内镜注气经浆膜下剥离进行腹腔镜局部切除（LRSDEA），用于治疗位于食管胃交界附近的黏膜下肿瘤（SMT - EGJ），以避免进行胃大部切除术。
共有9例患者接受了LRSDEA手术。我们依次进行了：在食管胃交界周围进行腹腔镜剥离，使用腹腔镜电灼和超声刀在黏膜下肿瘤周围进行浆膜下剥离，最后摘除黏膜下肿瘤。在这些操作过程中，术中内镜肿瘤定位以及内镜注气确保了安全切除。这些操作过程见补充视频片段。对临床病理特征和手术结果进行了分析。
所有腹腔镜手术均成功完成，无需进行胃大部切除术。平均手术时间为126.1分钟，估计失血量为12.0毫升。无术后并发症。病理诊断为6例平滑肌瘤、2例胃肠道间质瘤和1例胃重复畸形。
LRSDEA是治疗SMT - EGJ的一种有效且安全的治疗选择，因为避免了胃的大部切除。
