腹腔镜手术对胃不同解剖部位胃肠间质瘤疗效的影响  

Impact of laparoscopic surgery on efficacy in the treatment of gastrointestinal stromal tumors in different anatomical locations

作　　者：陈清风[1] 林建贤[1] 郑朝辉[1] 李平[1] 谢建伟[1] 王家镔[1] 陆俊[1] 陈起跃[1] 林密[1] 曹龙龙[1] 黄昌明[1] 

机构地区：[1]福建医科大学附属协和医院胃外科,福州350001

出　　处：《中华胃肠外科杂志》2016年第11期1277-1281,共5页Chinese Journal of Gastrointestinal Surgery

基　　金：国家临床重点专科建设基金（[2012]649）;福建省科技计划重点项目（2014Y0025）

摘　　要：目的探讨腹腔镜手术对位于胃的不同解剖部位胃肠间质瘤（GIST）近、远期疗效的影响。方法回顾性分析2006年1月至2014年12月期间福建医科大学附属协和医院经腹腔镜手术治疗的133例胃GIST患者临床资料。根据2014版NCCN指南中将胃的解剖部位分成腹腔镜手术的Favorable部位（有利部位，包括胃底、胃体前壁及大弯侧）和Unfavorable部位（不宜部位，为肿瘤位于胃食管结合部、胃体小弯侧、胃体后壁、胃窦及幽门），本组患者肿瘤位于有利部位90例（有利部位组），位于不利部位43例（不宜部位组），比较两组患者手术后的近、远期疗效。结果两组患者的一般临床病理资料差异均无统计学意义（均P〉0．05）。有利部位组和不宜部位组的手术时间分别为（107．3±52．3）min和（119．0±53．4）min，术中失血量分别为（35．2±34．2）ml和（35．2±31．2）ml，差异均无统计学意义（均P〉0．05）；两组患者在术后首次排气时间、进食流质时间、住院时间和住院费用等方面比较，差异亦无统计学意义（均P〉0．05）。有利部位组和不宜部位组的总体并发症发生率分别为6．7％（6／90）和4．7％（2／43），Ⅰ～Ⅱ级并发症发生率分别为4．4％（4／90）和2．3％（1／43），Ⅲ-Ⅳ级并发症发生率分别为2．2％（2／90）和2．3％（1／43），差异均无统计学意义（P〉0．05）。全组患者中位随访时间36（1-84）月，有利部位组和不宜部位组患者的5年总体生存率分别为93.8％和95．2％，5年无复发生存率分别为81．1％和89．4％，差异均无统计学意义（均P〉0．05）。结论腹腔镜手术对位于胃的不同解剖部位胃GIST患者疗效相当。Objective To investigate the efficacy of laparoscopic surgery in the treatment of gastrointestinal stromal tumors （GIST） in different anatomical locations. Methods Clinical data of 133 patients with primary gastric GIST undergoing laparoscopic resection at our department from January 2006 to December 2014 were retrospectively analyzed. These patients were divided into favorable site group （F group, 90 cases）, including gastric fundus, anterior wall and greater curvature of gastric body, and unfavorable site group （UF group, 43 cases）,including gastroesophageal junction, posterior wall and lesser curvature of gastric body, antrum and pylorus, according to the 2014 version National Comprehensive Cancer Network Clinical Guidelines. Short-term and long-term efficacy between the two groups was compared. Results There were no significant differences between the two groups in the general clinicopathological parameters （all P 〉 0.05）. The operation time of F group and UF group was （107.3 ± 52.3） rain and （119±53.4） min respectively （P=0.21）. The blood loss in F group and UF group was （35.2 ± 34.2） ml and （35.2 ± 31.2） ml respectively （P = 1.00）. In ad.dition, there were no significant differences in time to first fluid diet, time to first flatus, postoperative hospital stay and hospitalization expenses between the two groups （all P〉 0.05）. In F group and UF group, morbidity of postoperative complication was 6.7% （6/90） and 4.7% （2/43） respectively （P = 0.72）, morbidity of category Ⅰ -Ⅱ complication was 4.4%（4/90） and 2.3%（1/43） respectively （P = 0.66）, and morbidity of category Ⅲ-Ⅳ complication was 2.2%（2/90） and 2.3% （1/43） respectively （P = 1.00）. Median follow-up time of all the cases was 36（1 to 84） months. The 5-year overall survival rates of F group and UF group were 93.8% and 95.2% respectively, and 5-year relapse-free survival rates were 81.1% and 89.4% respectively, without significant differences （both P 〉 0.

关 键 词：胃肠间质瘤 胃 解剖部位 腹腔镜手术 疗效 

分 类 号：R735[医药卫生—肿瘤]