Watanabe Megumi, Doita Susumu, Minagi Hitoshi, Miyake Eiki, Hatono Minami, Ogawa Toshihiro, Kimura Yuji, Taniguchi Fumitaka, Arata Takashi, Katsuda Ko, Tanakaya Koji, Aoki Hideki
Dept. of Surgery, National Hospital Organization Iwakuni Clinical Center.
Gan To Kagaku Ryoho. 2022 Dec;49(13):1449-1451.
Laparoscopy and endoscopy cooperative surgery(LECS)is a surgical procedure to avoid excessive resection of the gastrointestinal wall and preserve its function. For gastrointestinal stromal tumors(GIST)near the cardia and pylorus ring, the function of the cardia and pylorus can be preserved by minimum excision and hand-sewn suture closures. Here, we report a case successfully treated with inverted LECS for GIST near the pylorus ring. The patient was a 58-year-old male. Upper gastrointestinal endoscopy had revealed a 45 mm sized SMT near the pylorus ring. Biopsy by EUS-FNA indicated gastric GIST. The tumor was separated from the pylorus ring and inverted LECS was performed. The defect was closed with hand-sewn sutures, forming an L-shape. The postoperative course was good and he was discharged from hospital 10 days after surgery. It is considered that devising the direction of closure by means of the LECS procedure can preserve the pyloric function without passage obstruction or stasis, even for gastric GIST near the pylorus ring.
腹腔镜与内镜联合手术（LECS）是一种避免过度切除胃肠道壁并保留其功能的外科手术。对于靠近贲门和幽门环的胃肠道间质瘤（GIST），通过最小限度切除和手工缝合关闭，可以保留贲门和幽门的功能。在此，我们报告一例采用倒置LECS成功治疗幽门环附近GIST的病例。患者为58岁男性。上消化道内镜检查发现幽门环附近有一个45毫米大小的黏膜下肿瘤（SMT）。超声内镜引导下细针穿刺活检（EUS-FNA）显示为胃GIST。将肿瘤与幽门环分离并进行倒置LECS。用手工缝合关闭缺损，形成L形。术后病程良好，术后10天出院。认为通过LECS手术设计关闭方向，即使对于幽门环附近的胃GIST，也可以保留幽门功能而不出现通道梗阻或淤滞。
