内镜粘膜下剥离术和外科手术治疗胃间质瘤的临床对比研究  

Comparison of endoscopic submucosal dissection and surgery for treating gastric gastrointestinal stromal tumors

作　　者：章金艳[1] 刘明[1] 栗华[1] 郑建玮[1] 雷晓毅[1] 黄伟锋[1] 黄玉林[1] Zhang Jinyan;Liu Ming;Li Hua;et al(Department of Gastroenterology, the First Affliated Hospital of Xiamen University, Xiamen 361003)

机构地区：[1]厦门大学附属第一医院消化内科,福建厦门361003

出　　处：《中国现代医药杂志》2017年第12期39-43,共5页Modern Medicine Journal of China

摘　　要：目的通过与外科手术比较,评价内镜粘膜下剥离术(ESD)治疗胃间质瘤(GISTs)的临床结局。方法回顾性总结2012年1月?2017年1月行ESD或外科手术治疗的97例胃GISTs(肿瘤直径≤3.5cm)患者的临床资料,分析两组患者的基线特征、治疗效果、并发症和随访结果。结果 64例行ESD治疗(ESD组),33例行外科手术治疗(外科手术组)。外科手术组的平均肿瘤直径大于ESD组[(2.45±0.10)cm vs(1.47±0.81)cm,P<0.001]。ESD和外科手术组在肿瘤整块切除率(95.3%vs 100%,P=0.519)、完全切除率(92.2%vs 100%,P=0.244)和并发症发生率(10.9%vs 6.1%,P=0.678)等方面均无明显统计学差异。与外科手术组相比,ESD组平均手术时间短[(46.7±23.2)min vs(83.9±20.5)min,P<0.001],中位术后禁食时间短(3d vs 5d,P<0.001),中位术后住院时间短(6d vs 11d,P<0.001),中位总住院费用也低(16610元vs 39639元,P<0.001),两组在随访期间均未发现复发和转移病例。结论采用ESD技术治疗直径≤3.5cm的胃GISTs是安全、有效的,与外科手术治疗相比,其疗效相似,但创伤更小、术后恢复更快、术后住院时间更短、住院费用更低。Objective To evaluate the clinical outcomes of endoscopic submucosal dissection（ESD） for treating gastric gastrointestinal stromal tumors（GISTs） compared with surgical resection. Methods From Jan 2012 to Jan 2017,the medical records of 97 patients who were treated with ESD or surgery for gastric GISTs（tumor size≤3.5 cm） were investigated retrospectively. The baseline demographics,therapeutic efficacy,complications,and follow-up results of the two groups were retrospectively analyzed. Results 64 patients（ESD group） were treated by ESD and 33 patients（surgery group）underwent surgical resection. Tumor size was significantly larger in the surgery group than in the ESD group [（2.45±0.10）cm vs（1.47±0.81）cm, P〈0.001]. There were no significant differences between the ESD and surgery groups in terms of rates of en bloc resection（95.3% vs 100%, P=0.519）, complete resection（92.2% vs 100%, P=0.244） and complication（10.9% vs 6.1%, P=0.678）. Compared with surgery group, ESD was associated with shorter mean operation time [（46.7±23.2）min vs（83.9±20.5）min, P〈0.001], shorter post-procedural fasting time（median 3 d vs 5 d, P〈0.001）, shorter length of post-procedural hospital stays（median 6 d vs 11 d, P〈0.001）,and lower medical cost（median 16610 RMB vs 39639 RMB, P〈0.001）. No local recurrence or distant metastasis was found in either group during the follow-up period. Conclusion ESD is a safe and effective approach for treatment of gastric GISTs（tumor size≤3.5 cm）. ESD can achieve similar clinical efficacy when comparing with surgery. Additionally,ESD has the advantages of less trauma, faster recovery,shorter hospital stays and lower medical costs.

关 键 词：手术 内镜粘膜下剥离术 胃肠道间质瘤 

分 类 号：R735.2[医药卫生—肿瘤]