不同腹腔镜手术治疗胃底贲门部胃肠间质瘤疗效的多中心研究  

Efficacy of different laparoscopic surgeries for gastrointestinal stromal tumors of gastriccardia and fundus: a multicenter study

作　　者：张维富 冯兴宇 张鹏[3] 熊文俊 叶再生[5] 陈韬[6] 邱海波[7] 杨悦生 王伟[4] 陈路川[5] 余江[6] 王俊江[2] 吴德庆[2] 周志伟[7] 陶凯雄 李勇[2] Zhang Weifu;Feng Xingyu;Zhang Peng;Xiong Wenjun;Ye Zaisheng;Chen Tao;Qiu Haibo;Yang Yuesheng;Wang Wei;Chen Luchuan;Yu Jiang;Wang Junjiang;Wu Deqing;Zhou Zhiwei;Tao Kaixiong;Li Yong(The First Clinical Medical College,Guangdong Medical University,Zhanjiang 524023,Guangdong Province,China;Department of Gastrointestinal Surgery and General Surgery,Guangdong Provincial People′s Hospital(Guangdong Academy of Medical Sciences),Southern Medical University,Guangzhou 510080,China;Department of Gastrointestinal Surgery,Union Hospital,Tongji Medical College,Huazhong University of Science and Technology,Wuhan 430022,China;Department of Gastrointestinal Surgery,the Second Affiliated Hospital of Guangzhou University of Chinese Medicine,Guangdong Hospital of Traditional Chinese Medicine,Guangzhou 510120,China;Department of Gastrointestinal Surgery,Fujian Cancer Hospital,Affiliated Cancer Hospital,Fujian Medical University,Fuzhou 350014,China;Department of General Surgery,Nanfang Hospital,Southern Medical University,Guangzhou 510515,China;Department of Gastric Surgery,State Key Laboratory of Oncology in South China,Collaborative Innovation Center for Cancer Medicine,Sun Yat‐sen University Cancer Center,Guangzhou 510060,China;Shantou University Medical College,Shantou 515041,Guangdong Province,China)

机构地区：[1]广东医科大学第一临床医学院,湛江524023 [2]南方医科大学附属广东省人民医院(广东省医学科学院)胃肠外科,普通外科,广州510080 [3]华中科技大学同济医学院附属协和医院胃肠外科,武汉430022 [4]广东省中医院,广州中医药大学第二附属医院胃肠外科,广州510120 [5]福建省肿瘤医院,福建医科大学附属肿瘤医院胃肠肿瘤外科,福州350014 [6]南方医科大学附属南方医院普通外科,广州510515 [7]中山大学肿瘤防治中心胃外科,华南肿瘤学国家重点实验室,肿瘤医学协同创新中心,广州510060 [8]汕头大学医学院,汕头515041

出　　处：《中华消化外科杂志》2023年第4期519-525,共7页Chinese Journal of Digestive Surgery

基　　金：国家临床重点专科建设项目(2022YW030009);广东省自然科学基金面上项目(2020A1515010573);广州市科技计划项目(202102080230);广东省医学科学技术研究基金项目(A2020019)。

摘　　要：目的:探讨不同腹腔镜手术治疗胃底贲门部胃肠间质瘤(GIST)的疗效。方法:采用回顾性队列研究方法,收集2007年12月至2021年12月我国广东省人民医院等14家医学中心收治的251例行腹腔镜根治性切除术胃底贲门部GIST患者的临床病理资料;男123例,女128例;年龄为58(24,87)岁。观察指标:(1)治疗情况。(2)不同腹腔镜手术患者的临床病理资料情况。(3)特殊腹腔镜技术亚组分析。正态分布的计量资料以x±s表示,组间比较采用t检验或方差分析;偏态分布的计量资料以M(Q1,Q3)表示,组间比较采用Mann-Whitney U检验或Kruskal-Wallis H检验。计数资料以绝对数或百分比表示,等级资料比较采用秩和检验。结果:(1)治疗情况。251例患者中,202例行胃楔形切除术,26例行特殊腹腔镜技术(10例浆膜剥离切除术、16例经胃腔内切除术),23例行胃结构性切除术(6例全胃切除术、17例近端胃部分切除术)。251例患者中,24例出现术后并发症。(2)不同腹腔镜手术患者的临床病理资料情况。行胃楔形切除术患者性别(男、女),年龄,肿瘤最大径,手术时间,术中出血量,切口长度,术后首次进食全流质食物时间,术后首次进食半流质食物时间,术后住院时间,围手术期并发症,核分裂数(≤5/50高倍视野、6~10/50高倍视野、>10/50高倍视野),危险度分级(极低危险度、低危险度、中危险度、高危险度),肿瘤部位(贲门部、胃底部)分别为93、109例,(59±11)岁,3.50(0.40,10.00)cm,88.00(25.00,290.00)min,20.00(25.00,290.00)mL,4.00(2.00,12.00)cm,3.00(1.00,9.00)d,4.00(1.00,16.00)d,5.00(1.00,18.00)d,14例,164、31、7例,47、83、50、22例,30、172例;行特殊腹腔镜技术患者上述指标分别为19、7例,(49±14)岁,2.55(0.20,5.00)cm,101.00(59.00,330.00)min,27.50(2.00,300.00)mL,4.50(0,6.00)cm,2.50(1.00,10.00)d,4.00(1.00,16.00)d,6.00(1.00,18.00)d,3例,20、5、1例,15、5、2、4例,24、2例;行胃结构性切除术患者上述指标分别为11�Objective To investigate the efficacy of different laparoscopic surgeries for gastrointestinal stromal tumors(GIST)of gastric cardia and fundus.Methods The retrospective cohort study was conducted.The clinicopathological data of 251 patients with GIST of gastric cardia and fundus who underwent laparoscopic radical resection in 14 medical centers,including Guangdong Provincial People′s Hospital et al,from December 2007 to December 2021 were collected.There were 123 males and 128 females,aged 58(24,87)years.Observation indicators:(1)treatment;(2)clinicopathological data of patients undergoing different laparoscopic surgeries;(3)subgroup analysis for special laparoscopic techniques.Measurement data with normal distribution were represented as Mean±SD,and comparison between groups was conducted using the t test or ANOVA.Measurement data with skewed distribution were represented as M(Q1,Q3),and comparison between groups was conducted using the Mann-Whitney U test or Kruskal-Wallis H test.Count data were described as absolute numbers or percentages.Comparison of ordinal data was conducted using the rank sum test.Results(1)Treatment.Of the 251 patients,202 cases underwent gastric wedge resection,26 cases underwent special laparoscopic techniques including 10 cases with serotomy and dissection and 16 cases with transluminal gastrectomy,23 cases underwent structural gastrectomy including 6 cases with total gastrectomy and 17 cases with proximal partial gastrectomy.There were 24 patients had postoperative complications after surgery.(2)Clinicopathological data of patients undergoing different laparoscopic surgeries.The gender(male,female),age,tumor diameter,operation time,volume of intraoperative blood loss,length of incision,time to postoperative initial whole liquid food intake,time to postoperative initial semi-liquid food intake,duration of postoperative hospital stay,cases with perioperative complications,cases with mitotic count as≤5/50 high power field,6‒10/50 high power field,>10/50 high power field,cases be

关 键 词：胃肿瘤 胃底贲门部 胃肠间质瘤 外科手术 腹腔镜检查 

分 类 号：R735[医药卫生—肿瘤]