随着治疗内镜与腹腔镜技术的发展，胃黏膜下肿瘤的诊疗已由传统局部切除逐渐转向以超声内镜分层、组织学诊断、恶性风险评估和功能保护为基础的精准决策。胃黏膜下肿瘤的治疗不应简单追求“可切除”，而应首先判断是否需要治疗以及适合何种方式。腹腔镜与内镜联合手术（LECS）是在传统腹腔镜楔形切除和内镜全层切除基础上，结合腔内精准定位与腔外安全闭合优势形成的复合技术，尤其适用于腔内型、固有肌层来源以及贲门、幽门、后壁等功能敏感部位病灶。经典LECS、非暴露内镜壁内翻手术（NEWS）、腹腔镜-内镜联合入路肿瘤非暴露切除术（CLEAN-NET）等术式各有适应证和局限，尚无一种方式适用于所有病人。术者应结合病灶大小、部位、生长方式、污染和播散风险以及其中心技术条件，选择安全、简便、可重复且兼顾肿瘤学安全和胃功能保护的个体化方案。

With advances in therapeutic endoscopy and laparoscopic surgery, the diagnosis and management of gastric submucosal tumors have shifted from conventional local resection toward precision decision-making based on endoscopic ultrasonographic stratification, histological diagnosis, malignant risk assessment, and functional preservation. The treatment of gastric submucosal tumors should not simply pursue technical resectability; rather, it should begin with determining whether treatment is necessary and which approach is most appropriate. Laparoscopic and endoscopic cooperative surgery (LECS) is a hybrid technique developed on the basis of conventional laparoscopic wedge resection and endoscopic full-thickness resection, integrating the advantages of precise intraluminal localization and safe extraluminal closure. It is particularly suitable for intraluminal lesions, tumors originating from the muscularis propria, and lesions located in functionally sensitive areas such as the cardia, pylorus, and posterior gastric wall. Classical LECS, NEWS, CLEAN-NET, and other related techniques each have specific indications and limitations, and no single approach is applicable to all patients. Surgeons should select individualized strategies according to tumor size, location, growth pattern, risk of contamination and dissemination, and institutional expertise, with the goal of achieving safety, simplicity, reproducibility, oncological adequacy, and gastric functional preservation.