内镜全层切除术与透明帽辅助内镜全层切除术治疗老年患者胃小间质瘤的疗效比较  

omparison between endoscopic full-thickness resection and cap-assisted endoscopic full-thickness resection in the treatment of elderly patients with small gastric stromal tumors

作　　者：杨金萍 任喜梅 倪牧含 金祥雨 徐桂芳[1,2] Yang Jinping;Ren Ximei;Ni Muhan;Jin Xiangyu;Xu Guifang(Department of Gastroenterology,Nanjing Drum Tower Clinical College of Nanjing Medical University,Nanjing 210008,China;Department of Gastroenterology,Nanjing Drum Tower Hospital,The Affiliated Hospital of Nanjing University Medical School,Nanjing 210008,China;Anhui University of Traditional Chinese Medicine,Hefei 230012,China)

机构地区：[1]南京医科大学鼓楼临床医学院消化内科,南京210008 [2]南京大学医学院附属鼓楼医院消化内科,南京210008 [3]安徽中医药大学,合肥230012

出　　处：《中华消化内镜杂志》2023年第3期218-223,共6页Chinese Journal of Digestive Endoscopy

摘　　要：目的比较内镜全层切除术(endoscopic full-thickness resection,EFR)与透明帽辅助内镜全层切除术(cap-assisted EFR,EFR-C)治疗老年患者(≥60岁)胃小间质瘤(≤1.5 cm)的有效性及安全性。方法回顾性分析2012年5月—2020年8月在南京鼓楼医院接受EFR(41例)或EFR-C(25例)治疗的胃小间质瘤老年患者资料。比较EFR组和EFR-C组胃小间质瘤的临床病理特征、手术情况、术中及术后并发症、术后疗效、经济效益及随访情况。结果EFR组和EFR-C组的肿瘤R0切除率分别是95.1%(39/41)和100.0%(25/25);EFR组手术时间[45.0(32.5,66.5)min比30.0(20.0,42.5)min,U=259.500,P=0.001]及切除时间[30.0(20.0,50.5)min比9.0(6.5,16.5)min,U=127.000,P<0.001]均长于EFR-C组;EFR组热止血钳使用率高于EFR-C组[75.6%(31/41)比12.0%(3/25),χ^(2)=25.159,P<0.001];EFR组术后白细胞计数[8.3(6.6,10.4)×10^(9)/L比6.3(5.0,7.7)×10^(9)/L,U=271.000,P=0.001]及中性粒细胞百分比(77.6%±8.8%比73.0%±6.8%,t=2.256,P=0.027)均高于EFR-C组;EFR组术后抗生素使用天数多于EFR-C组[(2.8±2.0)d比(1.0±2.0)d,t=3.625,(P=0.001)];EFR组住院花费明显高于EFR-C组[(20595.0±3653.3)元比(13209.0±4458.9)元,t=7.323,P<0.001];随访期间内,2组患者均存活且肿瘤无复发或转移。结论EFR和EFR-C治疗老年人胃小间质瘤是安全有效的,与EFR相比,EFR-C手术时间较短、术后炎症反应较少、医疗费用更低,更适合老年患者胃小间质瘤的治疗。Objective To compare the safety and effectiveness of endoscopic full-thickness resection(EFR)and cap-assisted endoscopic full-thickness resection(EFR-C)in the treatment of small gastric stromal tumors(≤1.5 cm)in the elderly(≥60 years old).Methods Data of elderly patients with small gastric stromal tumors who received EFR(41 cases)or EFR-C(25 cases)at Nanjing Drum Tower Hospital from May 2012 to August 2020 were analyzed retrospectively.The clinicopathological characteristics,the procedures,intraoperative and postoperative complications,postoperative efficacy and economic benefits were compared between the two groups.Results The R0 resection rates of the EFR group and the EFR-C group were 95.1%(39/41)and 100%(25/25),respectively.The operation time[45.0(32.5,66.5)min VS 30.0(20.0,42.5)min,U=259.500,P=0.001]and resection time[30.0(20.0,50.5)min VS 9.0(6.5,16.5)min,U=127.000,P<0.001]of the EFR group were significantly longer than those of the EFR-C group.The rate of hot clamp use in the EFR group was higher than that in the EFR-C group[75.6%(31/41)VS 12.0%(3/25),χ^(2)=25.159,P<0.001].The postoperative white blood cell count[8.3(6.6,10.4)×10^(9)/L VS 6.3(5.0,7.7)×10^(9)/L,U=271.000,P=0.001]and postoperative neutrophil percentage(77.6%±8.8%VS 73.0%±6.8%,t=2.256,P=0.027)in the EFR group were higher than those in the EFR-C group.The postoperative antibiotic day in the EFR group was longer than that in the EFR-C group(2.8±2.0 days VS 1.0±2.0 days,t=3.625,P=0.001).The hospitalization costs in the EFR group were significantly higher than those in the EFR-C group(20595.0±3653.3 yuan VS 13209.0±4458.9 yuan,t=7.323,P<0.001).There was no recurrence or metastasis during the follow-up period.Conclusion EFR and EFR-C are safe and effective for the treatment of small gastric stromal tumors in the elderly.Compared with EFR,EFR-C needs shorter operation time and lower medical costs,yields less postoperative inflammation,and is more suitable for the treatment of small gastric stromal tumors in the elderly.

关 键 词：胃肠道间质肿瘤 老年 内镜下全层切除术 透明帽辅助 

分 类 号：R735.2[医药卫生—肿瘤]