背景:腹腔镜和内窥镜联合非暴露技术(CLEAN-NET)是一种腹腔镜和内窥镜协同手术(LECS)。它结合了腹腔镜胃切除术和内镜技术,用于胃肿瘤的局部切除,如胃肠道间质瘤(GIST),手术切缘很小。传统的CLEAN-NET外科手术是复杂的,需要小心的技术来保存贲门,特别是在附近的病变的情况下。我们描述了一个患者的情况,该患者接受了改良的CLEAN-NET入路,并在肿瘤底部周围进行了半圆形的浆膜层切口,与传统CLEAN-NET中的圆形浆膜层不同:在肿瘤周围保持粘膜连续性,作为避免术中肿瘤扩散的屏障。
方法:一名43岁的妇女因贲门附近的胃粘膜下肿瘤被转诊到我院,在体检中发现。根据内镜超声引导下细针穿刺的结果,该患者被诊断为胃GIST。改良的CLEAN-NET在card门相对侧的浆膜层的半圆形切口进行,使外科手术简单,并尽量减少胃壁的部分切除,包括肿瘤,同时保留贲门。手术时间为147分钟,术前失血量为3mL,术后住院时间为9天。切除的标本显示胃壁最小切除,包括肿瘤.贲门和胃神经被保留下来,术后进食良好。
结论:改良的CLEAN-NET半规型浆膜层剥离术是一种简单可靠的贲门附近GIST手术方法。
BACKGROUND: The combination of laparoscopic and endoscopic approaches to neoplasia with a non-exposure technique (CLEAN-NET) is a laparoscopic and endoscopic cooperative surgery (LECS). It combines laparoscopic gastric resection and endoscopic techniques for local resection of gastric tumors, such as gastrointestinal stromal tumors (GIST), with minimal surgical margins. A conventional CLEAN-NET surgical procedure is complex, requiring careful techniques to preserve the cardia, particularly in
case of nearby lesions. We describe the
case of a patient who underwent a modified CLEAN-NET approach with a semi-circular seromuscular layer incision surrounding the base of the tumor, different from a circular shape seromuscular layer in the conventional CLEAN-NET: around the tumor to preserve mucosal continuity, which acts as a barrier to avoid intraoperative tumor dissemination.
METHODS: A 43-year-old woman was referred to our hospital because of a gastric submucosal tumor near the cardia, detected on medical examination. The patient was diagnosed with gastric GIST based on the results of endoscopic ultrasound-guided fine-needle aspiration. Modified CLEAN-NET was performed with a semicircular incision of the seromuscular layer on the opposite side of the cardia, making the surgical procedure simple and minimizing partial resection of the gastric wall, including the tumor, while preserving the cardia. The operative time was 147 min, preoperative blood loss volume was 3 mL, and postoperative hospital stay was 9 days. The resected specimen revealed a minimal resection of the gastric wall, including the tumor. The cardia and gastric nerves were preserved, and the postoperative food intake was good.
CONCLUSIONS: The modified CLEAN-NET with semicircular seromuscular layer dissection is a simple and reliable surgical procedure for GIST near the cardia.