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目的探讨胃镜及超声胃镜联合胸腹腔镜简捷微创切除食道、胃、十二指肠上消化道直径>2cm良性肿瘤方法的可行性及其临床价值。方法 2005年06月至2009年02月,消化内科与腔镜外科、胸外科、麻醉科多科联合行微创手术,33例巨大广基良性肿瘤患者,在气管插管全身麻醉下,25例术中胃镜准确定位,超声胃镜确定病变的性质和深度,腹腔镜、胸腔镜行局部切除术。8例胃、十二指肠病例,由腹腔镜腔外保驾内镜行内镜下黏膜切除术或黏膜剥离术切除病变。结果胃镜+胸腔镜行3例巨大固有肌层食管平滑肌瘤切除术,腹腔镜+胃镜+超声内镜行胃切除术23例,十二指肠切除术5例,联合手术均一次性成功,手术时间15～39min,术中出血量10～30ml,无中转开腹。术中内镜定位准确,术后病理证实均完整切除,切缘无残留,无吻合口瘘、切口感染或腹腔内感染等并发症发生。术后住院4～6d,随访6个月～5年,无出血、胃漏等并发症发生及复发。结论食管、胃、十二指肠巨大广基良性病变,通过胃镜、腹腔镜、胸腔镜联合手术,优势互补,提高腔镜手术中病变定位的准确率及手术的成功率,大大降低开腹率,是一种简捷、安全、有效的微创治疗方式,具有创伤小、恢复快等优点,有着良好的临床应用前景。
Objective To investigate the feasibility and clinical value of endoscopic and endoscopic ultrasonography combined with thoraco-laparoscopy in the treatment of benign tumors with upper digestive tract diameter> 2cm in esophagus, stomach and duodenum. Methods From June 2005 to February 2009, 33 patients underwent general anesthesia with tracheal intubation and underwent minimally invasive surgery in Department of Gastroenterology and Endoscopic Surgery, Thoracic Surgery and Anesthesiology. Twenty-five patients Intraoperative gastroscope accurate positioning, ultrasound gastroscopy to determine the nature and depth of lesions, laparoscopy, thoracoscopic local excision. 8 cases of stomach, duodenum cases, endoscopic laparoscopic endoscopic endoscopic mucosal resection or mucosal dissection excision. Results Gastroscopy + thoracoscope in 3 cases of giant muscularis mucosa esophageal leiomyomactomy, laparoscopy + endoscopy + endoscopic gastrectomy in 23 cases, duodenal resection in 5 cases, the combined surgery were a one-time success, Surgery time 15 ~ 39min, intraoperative blood loss 10 ~ 30ml, no transit laparotomy. Intraoperative endoscopic positioning accuracy, postoperative pathology confirmed complete resection, no residual edge, no anastomotic leakage, incision infection or intra-abdominal infection and other complications. Hospitalized 4 ~ 6d after operation, followed up for 6 months to 5 years, no bleeding, gastric leakage and other complications and recurrence. Conclusion Esophageal, gastric and duodenal giant wide-based benign lesions, through gastroscopy, laparoscopy, thoracoscopic surgery, complement each other to improve the accuracy of endoscopic diagnosis and surgical operation of the success rate of surgery, greatly reducing the rate of open laparotomy , Is a simple, safe and effective way of minimally invasive treatment, with the advantages of less trauma and faster recovery, and has good clinical application prospects.