摘要
目的探讨内镜超声（endoscopic ultrasonography,EUS）联合腹腔镜诊治早期胃间质瘤（gastric stromal tumors,GSTs）的价值。方法2004年8月～2008年12月,应用EUS对18例早期GSTs（直径〈2cm）进行诊断,然后采用腹腔镜联合胃镜进行肿物定位,应用内镜切割吻合器（Endo-GIA）行肿物局部切除。结果18例手术均获得成功,术后无严重并发症。手术时间平均56min（35～110min）,术后住院平均4.4d（3～7d）。1例术后病理为神经鞘瘤;17例术后病理证实为GSTs,直径均〈2cm,核分裂像〈5个/50HPF,属极低度恶性,免疫组化检查显示17例CD117阳性,15例CD34阳性;EUS诊断阳性预测值为94.4%（17/18）。17例随访3～55个月,平均26.4月,无肿瘤复发及转移。结论EUS对早期GSTs有较高的诊断价值。对于早期发现的GSTs,应用腹腔镜局部切除,术中联合胃镜进行定位,提高手术操作效率和手术安全性。
Objective To explore the value of endoscopic ultrasonography（EUS）combined with laparoscopy in diagnosing and treating early gastric stromal tumors（GSTs）.Methods From August 2004 to December 2008,18 patients were primarily diagnosed with early GSTs by EUS.All of them underwent combined laparoscopicendoscopic surgery,which comprised of intraoperative gastroscopic guidance and laparoscopic wedge resection of the lesion by Endo-GIA.Postoperative outcome data of the patients were collected and analyzed.Results All the laparoscopic surgeries were accomplished successfully.No surgical mortalities or significant morbidities were noted.The mean operation time was 56 minutes（range,35-110 minutes）.The hospital stay ranged from 3 to 7 days with a mean of 4.4 days.Postoperative pathological examinations showed neurilemmoma in one case,while in the other 17 cases,the diagnosis was verified as GSTs by immunohistochemistry and pathology.The size of all the tumors was less 2 cm in diameter（range,0.8-1.9 cm）;and mitotic count were 〈5/50 HPF in all the cases,indicating very low malignancy.Immunohistochemical staining showed CD117 positive in 17 cases（100%）,and CD34 positive in 15 cases（88.24%）.Positive predictive value obtained by EUS was 94.4%（17/18）.The patients were followed up for 3 to 55 months（mean 26.4 months）,after which no recurrent or metastatic tumors were found.Conclusions EUS is of high value in early diagnosis of GSTs.Laparoscopic resection combined with intraoperative gastroscopic guidance and preoperative EUS evaluation,is a safe and appropriate approach for early GSTs.
出处
《中国微创外科杂志》
CSCD
2010年第5期399-401,408,共4页
Chinese Journal of Minimally Invasive Surgery
关键词
胃间质瘤
胃镜
内镜超声
腹腔镜
Gastric stromal tumors
Gastroscopy
Endoscopic ultrasonography
Laparoscopy
