Laparoscopy Combined With Endoscopy In Clinical Application Of Surgical Operation Of Gastric Stromal Tumor

1Experimental objective:Discussion on the technology of laparoscopy combined with endoscopy in gastrointestinal stromal tumor (Gastric Stromal Tumor, GST) the clinical value of surgical treatment and evaluation of clinical value of postoperative patients with Imatinib.2Exper iment methods:Retrospective analysis of our hospital from october2008to august2011completed48cases of surgical treatment of gastric stromal tumors:27patients (group a) application of laparoscopy combined with endoscopic technique the tumor,21patients (Group b) traditional laparotomy in the treatment and follow-up of patients with tumor recurrence or metastasis. To study surgery, intraoperative bleeding and postoperative recovery time, complications, postoperative hospitalization time, clinical pathology results indicators and pathological results, high risk for patients taking Imatinib drug-, observation and follow-up of patients with tumor recurrence or metastasis.3Experiment results:48cases of GST in the average age of onset is56.9years. Tumor diameter0.8-8.3cm, averaging4.14cm in diameter, its clinical manifestations:a dull pain in the upper abdomen in25cases (52.1%), Black10(20.8%), bloating in7cases (14.6%). No obvious clinical symptoms in6cases (12.5%). Before operation a total of7cases (seven-forty eighths), endoscopic ultrasound fine needle aspiration biopsy,5have been confirmed as Stromal Tumors, a total of30cases of gastroscopy, only3cases of endoscopic biopsy in the diagnosis of gastric stromal tumor.48cases patients with tumor specimen (Figure1) get frozen, postoperative Pathology:endoscopic main spindle cell-oriented (Figure2-1). Immunohistochemistry:CD117-positive rate (95.8%)(Figure2-2), CD34-positive rate (70.8%)(Figure2-3).48cases have been successful, clinical analysis of postoperative:compared to group a and group b:①tumor size3.86±VS4.51±1.58cm,P>0.05, no statistically significant differences between the two.②operation time:109.3±VS99.09± 17.08min,P>0.05, no statistically significant differences between the two.③bleeding25.33±VS44.57±ml,P<0.05, there is a statistically significant difference.④36.96±postoperative gastrointestinal recovery time VS61.14±13.51h,P<0.05, there is a statistically significant difference.⑤the postoperative average hospital days:6.22±VS12.14±days, P<0.05, there is a statistically significant difference. Postoperative complications:a group with mild lung infection after operation in2cases, the anti-inflammation treatment cure. B and wound seroma1example,1cases of wound infection.Laparoscopy combined with endoscopic surgery with surgery time is shorter, less bleeding during surgery, eating early postoperative recovery, shorter postoperative hospital stay and other significant advantages, no major postoperative complications. According to Fletcher,[1] in the United States national meeting of health based on the tumor size and the number of the nuclear fission of stromal tumor risk rating criteria, based on specimens of patients with pathological results after a reasonable set of three classified as high risk, medium risk, low risk, and novel drug treatments. A group at low risk of19cases. crises in5cases,3patients at high risk, low risk of10cases of Group b, crisis in6cases,5patients at high risk. Low risk (60.4%), crisis (22.9%), high risk (16.7%).29cases of postoperative patients with low risk of GST not be Imatinib therapy, follow-up12-30months, no recurrence or metastasis of tumor.5cases (five-elevenths), dangerous and4cases in high risk (4/8) GST for3months in patients with Imatinib in treatment of400mg/d, and postoperative follow-up of June-30months,1critical GST in follow-up of patients with recurrence of6th month,8(eight-nineths) no recurrence or metastasis has occurred.6cases (six-elevenths) critical and4(four-eighths) not Imatinib in patients with high-risk GST treatment, follow-up6-30months, of which1(one-sixth) in critical patients relapse, recurrence time for the follow-up of the14th month,2case (two-fourths) for relapse in patients with high-risk GST, respectively for follow-up of the8th month,12th month. Postoperative application of Imatinib in the treatment group and not with Imatinib in the treatment group, compared the two, the difference was not significant statistically, P>0.05. 4Conclusion:4.1GST with no specific clinical symptoms of digestive tract, and other gastrointestinal diseases difficult to distinguish, which grew up in the submucous, preoperative get the pathological be difficult to push through gastroscope diagnosis and Endoscopic Ultrasonography guided fine-needle aspiration biopsy combined with immunohistochemistry check CD117,CD34you can make the confirmed rate increase, the current diagnosis of Abdominal CT to your preferred method.4.2Complete tumor surgery, specimens negative margin remains the standard requirements of GST, intraoperative endoscopy location, and check the results after resection of, general2-3cm margin from the tumor, but not really looking for negative edge under a microscope.4.3Laparoscopy combined with endoscopic surgery of trauma Treatment of GST smaller, less blood loss, postoperative gastrointestinal recovery Come on, eat Early Postoperative recovery, average length less, fewer complications, merits promotion, but in general for small GST (5cm in diameter), if tumor is large, hand-assisted laparoscopic technique can be used, generally advocated open surgery.4.4Imatinib (gliveec) to a potential malignant and malignant stromal tumors in patients with Postoperative adjuvant therapy has an important value, for patients with unresectable or the transfer also have a noticeable effect. For patients with imatinib resistance, such as Sunitinib drug therapy can be applied.Laparoscopy combined with endoscopic surgical treatment of Gastric Stromal Tumor:security, minimally invasive surgery is more ideal. gastroscopy in laparoscopic surgery with the tumor location and secondary operations, the important role of postoperative check the effect of resection, combined laparoscopic resection of Gastric Stromal Tumor of gastroscope for small size effect of stromal tumors must have, long-term effects require further observation.In addition, the new secondary drugs for GST with metastatic high, the crisis in relatively effective control.