【摘要】 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。更多还原

【Abstract】 Objective To investigate the clinical values of thoracoscopy、 laparoscopy combined with gastroscopy、 ultrasonic gastroscopy for treating upper gastrointestinal benign tumors. Methods Clinicopathologic features and follow-up results of 33 consecutive patients undergoing a combined thoracoscopic、laparoscopic-endoscopic approach for upper gastrointestinal tumors were prospectively analyzed. After localizing with gastroscopy and determining the property and depth, Twenty six tumors were locally resected in minimal invasion by thoracoscopy、 laparoscopy;other five tumors were done by endoscopic mucosal resection or endoscopic submucosal dissection with laparoscopically assisted endoscopic snare resection. Results Upper gastrointestinal benign tumors in 33 cases were localizly resected under laparoscopy combined with gastroscopy successfully. Mean operative time was 15-39min;There was no any complication . The average postoperative hospital stay was 4-7days. Conclusions Combined thoracoscopic、 laparoscopic- endoscopic "rendez-vous" procedures are easy to perform and offer a curative approach for almost all upper gastrointestinal benign tumors.The technique is reliable and efective in clinical application,due to the advantages of accurate and quick localization of tomour.更多还原