Department of Surgery, Chung-Ang University Gwangmyeong Hospital, Gwangmyeong, Republic of Korea.
Department of Surgery, Seoul National University Bundang Hospital, 300 Gumi-dong, Bundang-gu, Seongnam-si, Gyeonggi-do, 13620, Republic of Korea.
Surg Endosc. 2024 Feb;38(2):1106-1112. doi: 10.1007/s00464-023-10583-z. Epub 2023 Dec 18.
Intragastric wedge resection is an effective method for treating endophytic gastric subepithelial tumors (SETs). However, retracting the stomach wall to the umbilicus is difficult in certain patients. In response, we developed a novel surgical technique for single-port intragastric wedge resection, which we termed the "tunnel method."
A transumbilical incision is made, and a wound retractor is applied. After diagnostic laparoscopy, a gastrostomy is made on the greater curvature, lower body. Another small wound retractor is inserted into the gastrostomy, and extracted through the transumbilical incision, creating a tunnel from the gastrostomy site to the umbilicus. Articulating laparoscopic instruments are inserted via the tunnel, and intragastric wedge resection is performed. We collected and analyzed the clinicopathologic and operative data of patients who underwent intragastric wedge resection via the tunnel method.
Twenty-seven patients who underwent single-port intragastric wedge resection via the tunnel method in a single tertiary referral hospital were included in this study. The mean age of the patients was 54.6 ± 11.4 years, body mass index was 26.5 ± 3.4 kg/m. Twenty-four (88.9%) patients had tumors located in the upper third of the stomach. The average operative time was 65.0 ± 24.2 min. None of the patients experienced Clavien-Dindo grade IIIa or higher postoperative complications. The average postoperative hospital stay length was 2.5 ± 0.8 days. Thirteen gastrointestinal stromal tumors, nine leiomyomas, and one neuroendocrine carcinoma, schwannoma, lipoma, spindle cell proliferative lesion, and fibrotic lesion were pathologically diagnosed. The average tumor size was 2.6 ± 1.3 cm. All cases had negative resection margins.
Single-port intragastric wedge resection by the tunnel method is a feasible and safe approach for treating endophytic gastric SETs.
胃腔内楔形切除术是治疗内生型胃黏膜下肿瘤（SET）的有效方法。然而，对于某些患者来说，将胃壁拉至脐部是困难的。针对这种情况，我们开发了一种新的单孔胃腔内楔形切除术手术技术，我们称之为“隧道法”。
在脐部做一个切口，应用一个切口牵开器。在诊断性腹腔镜检查后，在胃大弯、胃体下部做一个胃造口。另一个小的切口牵开器插入胃造口，通过脐部切口取出，在胃造口部位和脐部之间建立一个隧道。通过隧道插入关节式腹腔镜器械，进行胃腔内楔形切除术。我们收集和分析了在一家三级转诊医院接受隧道法单孔胃腔内楔形切除术的患者的临床病理和手术数据。
本研究共纳入 27 例在一家三级转诊医院接受隧道法单孔胃腔内楔形切除术的患者。患者的平均年龄为 54.6±11.4 岁，体重指数为 26.5±3.4kg/m²。24 例（88.9%）患者的肿瘤位于胃的上 1/3 部。平均手术时间为 65.0±24.2 分钟。无患者发生 Clavien-Dindo Ⅲa 级及以上术后并发症。平均术后住院时间为 2.5±0.8 天。病理诊断为 13 例胃肠道间质瘤、9 例平滑肌瘤和 1 例神经内分泌癌、神经鞘瘤、脂肪瘤、梭形细胞增殖性病变和纤维性病变。平均肿瘤大小为 2.6±1.3cm。所有病例均切缘阴性。
隧道法单孔胃腔内楔形切除术是治疗内生型胃 SET 的一种可行且安全的方法。
